The diagnosis of low-grade dysplasia in Barrett's esophagus and its implications for disease progression - PubMed (original) (raw)
The diagnosis of low-grade dysplasia in Barrett's esophagus and its implications for disease progression
M Skacel et al. Am J Gastroenterol. 2000 Dec.
Abstract
Objective: The reported risk of progression from low-grade dysplasia (LGD) to high-grade dysplasia (HGD) or carcinoma (CA) in Barrett's esophagus varies. However, the validity of a diagnosis of LGD may be questioned because of interobserver variability.
Methods: A search of the Cleveland Clinic Foundation surgical pathology files between 1986 and 1997 yielded biopsy specimens from 43 patients with Barrett's esophagus diagnosed and coded as LGD. Patients with concurrent or prior diagnoses of HGD or carcinoma were excluded. The LGD cases were randomized and blindly reviewed by three gastrointestinal (GI) pathologists along with cases originally diagnosed as Barrett's esophagus without dysplasia (ND; n = 28), indefinite for dysplasia (IND; n = 14), or HGD (n = 15). Each pathologist classified every biopsy specimen as ND, IND, LGD, or HGD, and interobserver agreements were determined by kappa statistics (K). Follow-up data were available on 25 patients originally diagnosed with LGD. Progression was defined as a subsequent diagnosis of HGD or CA on esophageal biopsy or resection specimens.
Results: Agreement between two GI pathologists for a diagnosis of LGD was fair (K = 0.28) and poor (K = 0.21 and -0.04). Individual GI pathologists agreed with the original diagnosis of LGD in 70%, 56%, and 16% of cases. The 25 patients with follow-up included 21 men and four women (mean age, 67 yr) with a mean follow-up of 26 months (range: 2-84 months). Seven patients (28%) with follow-up developed HGD (five patients) or CA (two patients), 2-43 months (median: 11 months) after a diagnosis of LGD. The individual GI pathologists' diagnosis did not correlate with progression. However, when at least two GI pathologists agreed on LGD, there was a significant association with progression (seven of 17 patients, 41%, p = 0.04). When all three GI pathologists agreed on a diagnosis of LGD, four of five patients progressed (p = 0.012). In contrast, of the eight patients with follow-up and no agreement among GI pathologists for a diagnosis of LGD, none progressed.
Conclusions: A high degree of interobserver variability is seen in the histological diagnosis of Barrett's esophagus-related LGD. Although the number of observations is low, a consensus diagnosis of LGD among GI pathologists suggests an increased risk of progression from LGD to HGD or carcinoma.
Similar articles
- p53 expression in low grade dysplasia in Barrett's esophagus: correlation with interobserver agreement and disease progression.
Skacel M, Petras RE, Rybicki LA, Gramlich TL, Richter JE, Falk GW, Goldblum JR. Skacel M, et al. Am J Gastroenterol. 2002 Oct;97(10):2508-13. doi: 10.1111/j.1572-0241.2002.06032.x. Am J Gastroenterol. 2002. PMID: 12385431 - Dysplasia as a predictive marker for invasive carcinoma in Barrett esophagus: a follow-up study based on 138 cases from a diagnostic variability study.
Montgomery E, Goldblum JR, Greenson JK, Haber MM, Lamps LW, Lauwers GY, Lazenby AJ, Lewin DN, Robert ME, Washington K, Zahurak ML, Hart J. Montgomery E, et al. Hum Pathol. 2001 Apr;32(4):379-88. doi: 10.1053/hupa.2001.23511. Hum Pathol. 2001. PMID: 11331954 - Low-grade dysplasia in Barrett's esophagus has a high risk of progression.
Lim CH, Treanor D, Dixon MF, Axon AT. Lim CH, et al. Endoscopy. 2007 Jul;39(7):581-7. doi: 10.1055/s-2007-966592. Endoscopy. 2007. PMID: 17611911 - [Barrett's oesophagus: endoscopic diagnosis and follow-up].
Ponsot P. Ponsot P. Ann Chir. 2006 Jan;131(1):3-6. doi: 10.1016/j.anchir.2005.11.003. Epub 2005 Dec 1. Ann Chir. 2006. PMID: 16376849 Review. French. - Controversies in Barrett's esophagus: management of high grade dysplasia.
Sharma P. Sharma P. Semin Gastrointest Dis. 2001 Jan;12(1):26-32. Semin Gastrointest Dis. 2001. PMID: 11215852 Review.
Cited by
- Quantitative evaluation of in vivo vital-dye fluorescence endoscopic imaging for the detection of Barrett's-associated neoplasia.
Thekkek N, Lee MH, Polydorides AD, Rosen DG, Anandasabapathy S, Richards-Kortum R. Thekkek N, et al. J Biomed Opt. 2015 May;20(5):56002. doi: 10.1117/1.JBO.20.5.056002. J Biomed Opt. 2015. PMID: 25950645 Free PMC article. - Recurrent oesophageal intramucosal squamous carcinoma treated by endoscopic mucosal resection and subsequent radiofrequency ablation using HALO system.
Kajzrlikova I, Vitek P, Falt P, Urban O, Kominek P. Kajzrlikova I, et al. BMJ Case Rep. 2010 Dec 20;2010:bcr0820103211. doi: 10.1136/bcr.08.2010.3211. BMJ Case Rep. 2010. PMID: 22802374 Free PMC article. - Yield of Higher-Grade Neoplasia in Barrett's Esophagus With Low-Grade Dysplasia Is Double in the First Year Following Diagnosis.
Rubenstein JH, Waljee AK, Dwamena B, Bergman J, Vieth M, Wani S. Rubenstein JH, et al. Clin Gastroenterol Hepatol. 2018 Sep;16(9):1529-1530. doi: 10.1016/j.cgh.2018.01.002. Epub 2018 Jan 4. Clin Gastroenterol Hepatol. 2018. PMID: 29307847 Free PMC article. No abstract available. - [Barrett's esophagus and carcinoma: Recommendations of the S2k guideline 2014 and the S3 guideline 2015].
Lutz L, Werner M. Lutz L, et al. Pathologe. 2016 Mar;37(2):193-8; quiz 199-200. doi: 10.1007/s00292-016-0150-3. Pathologe. 2016. PMID: 26979429 German. - Disease Progression in Barrett's Low-Grade Dysplasia With Radiofrequency Ablation Compared With Surveillance: Systematic Review and Meta-Analysis.
Qumseya BJ, Wani S, Gendy S, Harnke B, Bergman JJ, Wolfsen H. Qumseya BJ, et al. Am J Gastroenterol. 2017 Jun;112(6):849-865. doi: 10.1038/ajg.2017.70. Epub 2017 Apr 4. Am J Gastroenterol. 2017. PMID: 28374819 Review.
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical