COMMENTARY

Gastrointestinal cancer

Observer variation in the diagnosis of superficial oesophageal adenocarcinoma: another spanner in the works?

D Alderson

University Division of Surgery, Level 7, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK; derek.alderson@bristol.ac.uk

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The distinction between high grade dysplasia and intramucosal carcinoma is not easily made by expert pathologists, with little improvement even after agreeing on uniform criteria for the use of

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Keywords: oesophagus; carcinoma; high grade dysplasia; interobserver agreement

The first 150 words of the full text of this article appear below.

The rapidly rising incidence of oesophageal adenocarcinoma in the Western world has stimulated considerable experimental and clinical research in recent years. After a long period of uncertainty, it is now generally held that the majority, if not all, of these cancers arise on a background of intestinal metaplasia (Barrett’s oesophagus), secondary to chronic gastro-oesophageal reflux. While there has been much debate on the risk of cancer development, it is again accepted that in a proportion of patients, this metaplastic epithelium becomes unstable, leading to a sequential progression through dysplasia to carcinoma. Considerable effort has gone into characterising the changes which seem to occur at the molecular level ¹.

In this issue, Ormsby and colleagues² suggest that it may be important to distinguish high grade dysplasia (HGD) from intramucosal carcinoma (IMC) in order to reach a decision about endoscopic surveillance and how this might influence the nature and timing . . . [Full text of this article]

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This article has been cited by other articles:

• Barr, H, Stone, N, Rembacken, B (2005). ENDOSCOPIC THERAPY FOR BARRETT'S OESOPHAGUS. Gut 54: 875-884 [Full Text]