Pathology lab leads new frontier in esophageal cancer testing

Domenico Coppola, MD, FASCP, FCAP, medical director at Florida Digestive Health Specialist’s Department of Pathology, recently published study results that will improve testing accuracy for patients who are at an increased chance of developing esophageal cancer.

Barrett’s Esophagus is a condition in which the squamous lining of the esophagus changes to lining similar to that present in the small intestine. In some patients such modification is precancerous and carries an increased risk of developing esophageal cancer.

Current testing for Barrett’s utilizes microscopic examination and a special stain (Alcian blue) to detect the  presence of specific cells, called “Goblet cells”. Current medical guidelines, require the presence of “Goblet cells” for the diagnosis of Barrett’s esophagus. The FDHS’s study, is showing that CDX2 immunostain positivity identifies patients that have higher chance of developing goblet cells (Barrett’s esophagus) before such change is microscopically detectable. Knowing which patient has a higher risk to develop BE is important for gastroenterologists to design a patients’ follow-up schedule at shorter intervals to be able to detect BE as soon as it develops.  

“CDX2 serves as an important early indicator for Barrett’s Esophagus,” said Coppola. “This added layer of testing will allow early detection and treatment of BE patients progressing to dysplasia/cancer.”

This is the first test that provides statistically significant evidence to prove these outcomes. The research was published in early November in Springer’s Digestive Diseases and Sciences journal, a peer-reviewed publication focusing on gastroenterology and hepatology.

Coppola was appointed Florida Digestive Health Specialists’ medical director in April 2019 and is focused on continuing to lead studies that will improve patient outcomes. With a team of pathologists, histologists and technicians in Lakewood Ranch, he oversees pathology testing for the 24 care centers.