DNA image cytometry test for primary screening of esophageal cancer: a population-based multi-center study in high-risk areas in China

Abstract

Objective To evaluate the feasibility of DNA image cytometry (DNA-ICM) as a primary screening method for esophageal squamous cell cancer (ESCC). Methods A total of 5,382 local residents aged 40–69 years from three high-risk areas in China (Linzhou in Henan province, Feicheng in Shandong province and Cixian in Hebei province) from 2008 to 2011 were recruited in this population-based screening study. And 2,526 subjects declined to receive endoscopic biopsy examination with Lugol’s iodine staining, while 9 and 815 subjects were excluded from liquid-based cytology and DNA-ICM test respectively due to slide quality. Finally, 2,856, 5,373 and 4,567 subjects were enrolled in the analysis for endoscopic biopsy examination, liquid-based cytology and DNA-ICM test, respectively. Sensitivity (SE), specificity (SP), negative predictive values (NPV) and positive predictive values (PPV) as well as their 95% confidence intervals (95% CI) for DNA-ICM, liquid-based cytology and the combination of the two methods were calculated. Receiver operating characteristic (ROC) curves were applied to determine the cutoff point of DNA-ICM for esophageal cancer. Results DNA-ICM results were significantly correlative with esophageal cancer and precancer lesions (χ2=18.016, P<0.001). The cutoff points were 5,802, 5,803 and 8,002 based on dissimilar pathological types of low grade intraepithelial neoplasia (LGIN), high grade intraepithelial neoplasia (HGIN), and ESCC, respectively, and 5,803 was chosen in this study considering the SE and SP. The SE, SP, PPV, NPV of DNA-ICM test (cutoff point 5,803) combined with liquid-based cytology [threshold atypical squamous cells of undetermined significance (ASCUS)] were separately 72.1% (95% CI: 70.3%-73.9%), 43.3% (95% CI: 41.3%-45.3%), 22.8% (95% CI: 21.1%-24.5%) and 87.0% (95% CI: 85.7%-88.3%) for LGIN, 85.7% (95% CI: 84.3%-87.1%), 41.3% (95% CI: 39.3%-43.3%), 4.6% (95% CI: 3.8%-5.4%) and 98.9% (95% CI: 98.5%-99.3%) for HGIN, and 96.0% (95% CI: 95.2%-96.8%), 40.8% (95% CI: 38.8%-42.8%), 1.7% (95% CI: 1.2%-2.2%) and 99.9% (95% CI: 99.8%-100.0%) for ESCC. Conclusions It is possible to use DNA-ICM test as a primary screening method before endoscopic screening for esophageal cancer.

Development and external validation of a nomogram to predict the risk of Upper gastrointestinal precancerous lesions in a non‐high‐incidence area

“…Moreover, to make the study completed almost perfectly, researchers and all staff involved also would put more effort to improve the participant rate through some special methods, like increasing communication with high‐risk participants, taking incentives, even contacting their children to persuade them to accept endoscopy, et al So the 29.1% of participation rate in cross‐sectional study over severe years are more authentic and natural. The rate in our study was lower than the participation rate (53.1%) in high‐incidence areas (Linxian in Henan province, Feicheng in Shandong province, and Cixian in Hebei province) 21 . Since 2005, the Chinese government has implemented a series of screening and early detection programs in 11 high‐risk areas.…”

“…The rate in our study was lower than the participation rate (53.1%) in high-incidence areas (Linxian in Henan province, Feicheng in Shandong province, and Cixian in Hebei province). 21 Since 2005, the Chinese government has implemented a series of screening and early detection programs in 11 high-risk areas. Public education campaign on the benefit of endoscopic screening has been ongoing for more than ten years in the high-risk areas while for only several years in the non-high-risk areas.…”

Knockdown of TGIF attenuates the proliferation and tumorigenicity of EC109 cells and promotes cisplatin‑induced apoptosis

“…There are two main histological types of esophageal cancer, including squamous cell carcinoma and adenocarcinoma ( 2 ). Although, the diagnosis and treatments for esophageal cancer update constantly ( 3 , 4 ), the overall 5-year survival rate is only around 20% ( 5 ). Therefore, it is important and urgent to elucidate an exactly novel molecular mechanism underlying esophageal cancer formation, which may provide new strategies for the diagnosis and treatments of esophageal cancer in future healthcare.…”

Value of automatic DNA image cytometry for diagnosing lung cancer

“…However, the DNA detection method is relatively simple and the training of specialized staff requires a few weeks. LBC diagnoses rely on the judgement of pathologists who require several years of specialized training ( 9 ). However, DNA-ICM can only judge the abnormal cells, but it cannot identify the types of tumor cell, including squamous carcinoma, adenocarcinoma and SCLC.…”