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

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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.