Progression from low-grade dysplasia to malignancy in patients with Barrett's esophagus diagnosed by two or more pathologists

Abstract

AIMTo evaluate annual incidence of low grade dysplasia (LGD) progression to high grade dysplasia (HGD) and/or esophageal adenocarcinoma (EAC) when diagnosis was made by two or more expert pathologists.METHODSStudies evaluating the progression of LGD to HGD or EAC were included. The diagnosis of LGD must be made by consensus of two or more expert gastrointestinal pathologists. Articles were searched in Medline, Pubmed, and Embase. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic.RESULTSInitial search identified 721 reference articles, of which 53 were selected and reviewed. Twelve studies (n = 971) that met the inclusion criteria were included in this analysis. Among the total original LGD diagnoses in the included studies, only 37.49% reached the consensus LGD diagnosis after review by two or more expert pathologists. Total follow up period was 1532 patient-years. In the pooled consensus LGD patients, the annual incidence rate (AIR) of progression to HGD and or EAC was 10.35% (95%CI: 7.56-13.13) and progression to EAC was 5.18% (95%CI: 3.43-6.92). Among the patients down staged from original LGD diagnosis to No-dysplasia Barrett’s esophagus, the AIR of progression to HGD and EAC was 0.65% (95%CI: 0.49-0.80). Among the patients down staged to Indefinite for dysplasia, the AIR of progression to HGD and EAC was 1.42% (95%CI: 1.19-1.65). In patients with consensus HGD diagnosis, the AIR of progression to EAC was 28.63% (95%CI: 13.98-43.27).CONCLUSIONWhen LGD is diagnosed by consensus agreement of two or more expert pathologists, its progression towards malignancy seems to be at least three times the current estimates, however it could be up to 20 times the current estimates. Biopsies of all Barrett’s esophagus patients with LGD should be reviewed by two expert gastroenterology pathologists. Follow-up strict surveillance programs should be in place for these patients.

Outcomes of Radiofrequency Ablation versus Endoscopic Surveillance for Barrett’s Esophagus with Low-Grade Dysplasia: A Systematic Review and Meta-Analysis

“…It is also important to note that the diagnosis of BE-LGD requires expert pathology review [26]. There is significant intra-and interobserver variability among pathologists, especially in the differentiation between NDBE, indefinite for dysplasia and LGD.…”

The Risk of Barrett’s Esophagus Transforming to Esophageal Cancer

“…32 but a recent pooled analysis estimated the annual progression rate from HGD to EAC to be 28.6%. 33 Based on above data, confirmed LGD and HGD (which is routinely confirmed by 2 pathologists) are important predictors of BE transforming to cancer.…”

The role of esophagectomy in the management of Barrett's esophagus with high‐grade dysplasia

“…22,[47][48][49][50][51][52][53][54] A recent pooled analysis found the rate from LGD to HGD/EAC and the rate from HGD to EAC to be 10.5% per annum and 28.6% per annum, respectively. 52 Given the cumulative ongoing risk of EAC, developing strategies to predict progression of disease has clinical relevance and may assist in targeting therapy to ensure effective treatment of disease and minimize the morbidity associated with overtreatment. One example is a validated model developed by Sravanthi et al using male sex, smoking, BE length, and the presence of dysplasia to predict the annual risk of progression after initial diagnosis of NDBE from a low-risk category (0.21% per annum) to a high-risk category (2.1% per annum).…”