Does CDX2 expression predict Barrett's metaplasia in oesophageal columnar epithelium without goblet cells?

Abstract

BACKGROUND:

Intestinal metaplasia (Barrett's oesophagus), but not cardiac-type mucosa in columnar-lined oesophagus, is regarded as premalignant. As intestinal metaplasia and cardiac-type mucosa are endoscopically indiscernible, it is difficult to take targeted samples from columnar-lined oesophagus with consequently a risk of having undetected intestinal metaplasia.

AIM:

To investigate whether the intestinal markers CDX2, MUC2 and villin can predict the presence of undetected intestinal metaplasia in columnar-lined oesophagus. Methods Presence of intestinal metaplasia or cardiac-type mucosa was identified in 122 biopsy sets of columnar-lined oesophagus from 61 patients, collected at two subsequent follow-up upper endoscopies. CDX2, MUC2 and villin expression were determined by immunohistochemistry.

RESULTS:

All intestinal metaplasia samples (55) were positive for CDX2 and MUC2 and 32 of 55 for villin. CDX2 expression was detected in 23 of 67 (34%) samples with only cardiac-type mucosa. Detection of CDX2 in cardiac-type mucosa increased the likelihood of finding intestinal metaplasia in another biopsy set of columnar-lined oesophagus (odds ratio 3.5, 95% CI = 1.2-10, P = 0.02). MUC2 was positive in 13 of 23 (57%) of CDX2-positive cardiac-type mucosa samples, whereas villin was detected in seven of 23 (30%).

CONCLUSIONS:

CDX2 expression in cardiac-type mucosa might be able to predict the presence of undetected intestinal metaplasia in columnar-lined oesophagus, and thus may be a putative marker for the presence of intestinal metaplasia in the absence of goblet cells.

• Authors: M Kerkhof, D A Bax, L M G Moons, A J van Vuuren, H van Dekken, E W Steyerberg, E J Kuipers, J G Kusters, P D Siersema, Cybar Study Group
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 24 Issue 11-12 Pg. 1613-21 (Dec 2006) ISSN: 0269-2813 [Print] England
• PMID: 17206949 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• CDX2 Transcription Factor
• CDX2 protein, human
• Homeodomain Proteins

Topics

• Adult
• Aged
• Aged, 80 and over
• Barrett Esophagus (pathology)
• Biomarkers (analysis)
• Biopsy (methods)
• CDX2 Transcription Factor
• Endoscopy, Gastrointestinal (methods)
• Esophagus (pathology)
• Goblet Cells (pathology)
• Homeodomain Proteins (metabolism)
• Humans
• Immunohistochemistry (methods)
• Metaplasia
• Middle Aged