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Barrett's oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel
  1. Lucas C Duits1,
  2. K Nadine Phoa1,
  3. Wouter L Curvers1,
  4. Fiebo J W ten Kate2,3,
  5. Gerrit A Meijer4,
  6. Cees A Seldenrijk5,
  7. G Johan Offerhaus2,3,
  8. Mike Visser2,
  9. Sybren L Meijer2,
  10. Kausilia K Krishnadath1,
  11. Jan G P Tijssen6,
  12. Rosalie C Mallant-Hent1,7,
  13. Jacques J G H M Bergman1
  1. 1Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
  2. 2Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands
  3. 3Department of Pathology, University Medical Centre, Utrecht, The Netherlands
  4. 4Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands
  5. 5Department of Pathology, St Antonius Hospital, Nieuwegein, The Netherlands
  6. 6Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
  7. 7Department of Gastroenterology and Hepatology, Flevoziekenhuis, Almere, The Netherlands
  1. Correspondence to Dr Jacques Bergman, Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; j.j.bergman{at}amc.uva.nl

Abstract

Objective Reported malignant progression rates for low-grade dysplasia (LGD) in Barrett's oesophagus (BO) vary widely. Expert histological review of LGD is advised, but limited data are available on its clinical value. This retrospective cohort study aimed to determine the value of an expert pathology panel organised in the Dutch Barrett's Advisory Committee (BAC) by investigating the incidence rates of high-grade dysplasia (HGD) and oesophageal adenocarcinoma (OAC) after expert histological review of LGD.

Design We included all BO cases referred to the BAC for histological review of LGD diagnosed between 2000 and 2011. The diagnosis of the expert panel was related to the histological outcome during endoscopic follow-up. Primary endpoint was development of HGD or OAC.

Results 293 LGD patients (76% men; mean 63 years±11.9) were included. Following histological review, 73% was downstaged to non-dysplastic BO (NDBO) or indefinite for dysplasia (IND). In 27% the initial LGD diagnosis was confirmed. Endoscopic follow-up was performed in 264 patients (90%) with a median follow-up of 39 months (IQR 16–72). For confirmed LGD, the risk of HGD/OAC was 9.1% per patient-year. Patients downstaged to NDBO or IND had a malignant progression risk of 0.6% and 0.9% per patient-year, respectively.

Conclusions Confirmed LGD in BO has a markedly increased risk of malignant progression. However, the vast majority of patients with community LGD will be downstaged after expert review and have a low progression risk. Therefore, all BO patients with LGD should undergo expert histological review of the diagnosis for adequate risk stratification.

  • Oesophageal Cancer
  • Barrett's Carcinoma
  • Barrett's Oesophagus
  • Dysplasia
  • Histopathology

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