Low-grade dysplasia diagnosis ratio and progression metrics identify variable Barrett’s esophagus risk stratification proficiency in independent pathology practices

Davison, Jon M.; Shah, Maulin; Deitrick, Christopher; Chennat, Jennifer; Fasanella, Ken E.; McGrath, Kevin

doi:10.1016/j.gie.2018.06.017

Cited by 7 publications

(4 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The 6.9% annual progression rate in NDBE patients scoring high risk with the assay is comparable with the progression rate in expert confirmed LGD in European studies ( 19 , 22 ) and even higher than the progression rate of expert-confirmed LGD in US studies ( 23 , 24 ). Since this risk prediction assay is able to identify both incident and prevalent progression ( 13 , 15 , 25 ), patients scoring high risk should be referred to a specialist with expertise in BE for a high-quality imaging endoscopy to exclude any visible lesions. After excluding any visible lesions, a management approach similar to the approach for confirmed LGD should be considered, which includes shorter surveillance intervals or EET.…”

Section: Discussionmentioning

confidence: 99%

Independent Validation of a Tissue Systems Pathology Assay to Predict Future Progression in Nondysplastic Barrett's Esophagus: A Spatial-Temporal Analysis

Frei¹,

Konté²,

Bossart

et al. 2020

Clin Transl Gastroenterol

View full text Add to dashboard Cite

INTRODUCTION: An automated risk prediction assay has previously been shown to objectively identify patients with nondysplastic Barrett's esophagus (NDBE) who are at increased risk of malignant progression. To evaluate the predictive performance of the assay in 76 patients with NDBE of which 38 progressed to high-grade dysplasia/esophageal adenocarcinoma (progressors) and 38 did not (nonprogressors) and to determine whether assessment of additional (spatial) levels per endoscopy and/or multiple (temporal) time points improves assay performance. METHODS: In a blinded, nested case-control cohort, progressors and nonprogressors were matched (age, sex, and Barrett's esophagus length). All random biopsy levels from the baseline endoscopy (spatial samples) and all available previous endoscopies back to 10 years before progression (temporal samples) were assayed. Because the 1:1 ratio of progressors to nonprogressors does not reflect the real-world Barrett's population, negative and positive predictive values were adjusted for prevalence. RESULTS: Seventy-six patients (58 men), mean age of 63 ± 9 years, were studied. A high-risk score was associated with a prevalence-adjusted annual progression rate of 6.9%. The assay identified 31% of progressors when assessing a single biopsy level from the baseline endoscopy. Sensitivity increased to 50% and 69% in spatial and temporal analyses, respectively, while specificity remained at 95%. DISCUSSION: The assay identified a significant subset of NDBE patients who progress at a rate comparable with published estimates for expert-confirmed low-grade dysplasia. Assessing additional spatial and temporal biopsies increased the predictive accuracy, allowing for identification of most future progressors. Additional studies will evaluate the predictive performance of the assay in low-prevalence settings.

show abstract

Section: Discussionmentioning

confidence: 99%

Independent Validation of a Tissue Systems Pathology Assay to Predict Future Progression in Nondysplastic Barrett's Esophagus: A Spatial-Temporal Analysis

Frei¹,

Konté²,

Bossart

et al. 2020

Clin Transl Gastroenterol

View full text Add to dashboard Cite

show abstract

“…This study was approved by the University of Pittsburgh Institutional Review Board (PRO15080138, 10/16/2015). We used a database 23 to identify BO patients who underwent endoscopic surveillance biopsy from 2010 to 2016 in our institution, diagnosed with non-dysplastic Barrett's oesophagus (NDBO), indefinite dysplasia (IND) or LGD, no prior diagnosis of HGD or OAC and no prior ablation or oesophageal surgery. We reviewed the history of all patients subsequently diagnosed with HGD or OAC and excluded patients with HGD or OAC diagnosed elsewhere prior to referral to our institution for treatment, and all patients with locally advanced malignancies referred for treatment.…”

Section: P a T I E N T S E L E C T I O Nmentioning

confidence: 99%

Use of p53 immunohistochemistry in conjunction with routine histology improves risk stratification of patients with Barrett’s oesophagus during routine clinical care

Tokuyama

Geisler²,

Deitrick³

et al. 2020

Histopathology

Self Cite

View full text Add to dashboard Cite

Aims Abnormal p53 protein expression detected by immunohistochemistry (IHC) in Barrett’s oesophagus (BO) is reported to be a prognostic biomarker for progression to high‐grade dysplasia (HGD) or oesophageal adenocarcinoma (OAC). We evaluated our use of p53 IHC for patients with BO under surveillance from 2010 to 2016 in a single academic institution. Methods and results We identified 78 patients under surveillance for BO who had biopsies evaluated for abnormal p53 expression in conjunction with routine histology and 892 patients who had histological evaluation alone. All available p53 IHC slides were rescored as wild‐type or abnormal. We evaluated the risk of subsequent diagnosis with HGD and OAC. p53‐tested patients were significantly more likely to be diagnosed with indefinite dysplasia (IND) or low‐grade dysplasia (LGD), compared to patients who were not tested (79.5 versus 10.8%, P = 7.4 × 10−40). Almost half (46.9%) of patients with abnormal p53 expression were diagnosed with HGD or OAC within 5 years, compared to 5.9% with wild‐type p53, and 7.6% of patients not tested (P = 2.6 × 10−18). However, this difference was heavily influenced by other risk factors, including dysplasia grade, in multivariate analyses. In the subgroup of patients diagnosed with IND (n = 109), abnormal p53 expression was associated with a fourfold increase (1.2–13.3, P = 0.023) in risk of HGD/OAC relative to untested patients diagnosed with IND, independent of other risk factors. Conclusion In patients under surveillance for BO in a single academic institution, we found evidence that selective use of p53 IHC in conjunction with routine histology modestly improved risk stratification by identifying patients with IND at higher risk of a subsequent diagnosis of HGD or OAC.

show abstract

“…A diagnosis of low-grade dysplasia (LGD) confirmed by a gastrointestinal subspecialist pathologist is a significant predictor of progression to high-grade dysplasia (HGD) and EAC, and current society guidelines recommend EET or increased surveillance for patients with BE who have confirmed LGD [4,8]. However, the reported progression rates for confirmed LGD vary widely and overdiagnosis of LGD is common [6,7,[9][10][11], making it unclear whether therapeutic intervention is warranted TissueCypher Barrett's esophagus assay impacts clinical decisions in the management of patients with Barrett's esophagus ABSTR AC T Background and study aims The TissueCypher Barrett's Esophagus Assay is a novel tissue biomarker test, and has been validated to predict progression to high-grade dyspla-sia (HGD) and esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus (BE). The aim of this study was to evaluate the impact of TissueCypher on clinical decision-making in the management of BE.…”

Section: Introductionmentioning

confidence: 99%

TissueCypher Barrett’s esophagus assay impacts clinical decisions in the management of patients with Barrett’s esophagus

et al. 2021

View full text Add to dashboard Cite

Background and study aims The TissueCypher Barrett’s Esophagus Assay is a novel tissue biomarker test, and has been validated to predict progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in patients with Barrett’s esophagus (BE). The aim of this study was to evaluate the impact of TissueCypher on clinical decision-making in the management of BE. Patients and methods TissueCypher was ordered for 60 patients with non-dysplastic (ND, n = 18) BE, indefinite for dysplasia (IND, n = 25), and low-grade dysplasia (LGD, n = 17). TissueCypher reports a risk class (low, intermediate or high) for progression to HGD or EAC within 5 years. The impact of the test results on BE management decisions was assessed. Results Fifty-two of 60 patients were male, mean age 65.2 ± 11.8, and 43 of 60 had long segment BE. TissueCypher results impacted 55.0 % of management decisions. In 21.7 % of patients, the test upstaged the management approach, resulting in endoscopic eradication therapy (EET) or shorter surveillance interval. The test downstaged the management approach in 33.4 % of patients, leading to surveillance rather than EET. In the subset of patients whose management plan was changed, upstaging was associated with a high-risk TissueCypher result, and downstaging was associated with a low-risk result (P < 0.0001). Conclusions TissueCypher was used as an adjunct to support a surveillance-only approach in 33.4 % of patients. Upstaging occurred in 21.7 % of patients, leading to therapeutic intervention or increased surveillance. These results indicate that the TissueCypher test may enable physicians to target EET for TissueCypher high-risk BE patients, while reducing unnecessary procedures in TissueCypher low-risk patients.

show abstract

Low-grade dysplasia diagnosis ratio and progression metrics identify variable Barrett’s esophagus risk stratification proficiency in independent pathology practices

Cited by 7 publications

References 34 publications

Independent Validation of a Tissue Systems Pathology Assay to Predict Future Progression in Nondysplastic Barrett's Esophagus: A Spatial-Temporal Analysis

Independent Validation of a Tissue Systems Pathology Assay to Predict Future Progression in Nondysplastic Barrett's Esophagus: A Spatial-Temporal Analysis

Use of p53 immunohistochemistry in conjunction with routine histology improves risk stratification of patients with Barrett’s oesophagus during routine clinical care

TissueCypher Barrett’s esophagus assay impacts clinical decisions in the management of patients with Barrett’s esophagus

Contact Info

Product

Resources

About