S1053 Impact of Spatialomics Utilization on the Management of Non-Dysplastic Barrett's Esophagus in a Rural Community

Introduction: Spatialomics is an emerging technology that analyzes biological molecules in their natural tissue environment. We utilized a spatialomics-based computational platform that analyzes multiple biomarkers and tissue morphology features to provide an objective risk stratification for non-dysplastic Barrett's esophagus (NDBE). Our study aimed to evaluate the impact of such platform on the management of NDBE in a rural setting. Methods: This study enrolled all patients diagnosed with NDBE in rural Texas. We utilized the TissueCypher platform to risk-stratify NDBE cases. All specimens were analyzed using a spatialomics platform which evaluated 9 protein markers: p53, p16, and AMACR (associated with loss of tumor suppression and cell cycle dysregulation); CD68 and COX-2 (immune and inflammatory markers); HER-2 and CK20 (cancer growth and cellular transformation); and HIF-1α and CD45RO (angiogenesis and memory lymphocyte infiltration) and 7 key tissue characteristics: stroma, cells, epithelium, epithelial nuclei, nuclei, cytoplasm, and metaplastic epithelium. A risk stratification scoring system was utilized: low (score 0-5.4), intermediate (score 5.5-6.4), and high (score 6.5-10). Results: A total of 114 patients were diagnosed with NDBE from January 2023 to November 2024. Of these, 62 (54.4%) were women and 52 (45.6%) were men, with a mean age of 65.5 years (standard deviation [SD] 13.3, range 31-92 years). The mean BE segment length was 2.8 cm (SD 2.6 cm, range 0.3-18 cm). Spatialomics tests were performed on all 114 patients, though 8 specimens were “unreportable” due to insufficient tissues. Of the 106 reportable cases, the mean score was 2.5 (SD 1.7, range 0-7.8). The 5-year progression probability had a mean of 2.0% (SD 3.3, range 0.2-25%). Risk stratification identified 5 patients as intermediate risk and 2 as high risk; all these 7 patients underwent radiofrequency ablation resulting in complete eradiation of BE. The remaining 99 patients were downgraded to a surveillance interval of 5 years from our previous protocol of 2-3 years. Conclusion: The spatialomics platform had a significant impact on the management of NDBE in our study, influencing clinical decision-making in 93% of enrolled patients. Implementation of this technology facilitated timely intervention with eradication therapy for intermediate and high-risk patients. Additionally, it led to adjustment of surveillance interval in low-risk patients, optimizing resource utilization and reducing patient burden.