A morphometric method to discriminate normal from dysplastic/carcinoma in situ squamous epithelium in the human...

The possibility to differentiate normal squamous epithelium from dysplastic/cis in the human esophagus by means of quantitative morphometry was investigated in surgical specimens from 31 consecutive patients. The epithelium was divided into three equal zones, and a total of 186 areas was investigated. Of all variables employed, the interzonal variation between the three epithelial layers was the one showing the highest degree of efficiency (95%) in discriminating normal esophageal epithelium from dysplastic/cis lesions. Nuclear density, nuclear area, nuclear irregularity, nuclear parallelity and nuclear ovality were the most efficient discriminatory individual morphological variables. A 100% sensitivity in discriminating normal squamous epithelium from dysplastic/cis through morphometric evaluation was achieved by considering nuclear area in the superficial zone, nuclear perpendiculairty in the intermediate zone, nuclear density in the total epithelial thickness and interzonal variation of these variables. On the other hand, the specificity in discriminating dysplasia/cis lesions from normal squamous epithelium was only 96.8%. This was due to the fact that one case, by visual impression considered as dysplasia, was morphometrically recorded as normal. The view of that case showed that our initial visual impression of a dysplastic lesion proved to be erroneous, and today that case would be recorded as a reactive lesion due to chronic inflammation.