The Diagnosis of Low-Grade Dysplasia in Barrett's Esophagus and Its Implications for Disease Progression

Abstract

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.

Aberrant p53 protein expression is associated with an increased risk of neoplastic progression in patients with Barrett's oesophagus

“…Previous studies have shown that p53 overexpression is associated with an increased risk of neoplastic progression in non-dysplastic BO and BO with LGD. The results of these studies are in line with the results of our study 12 13 16 17 18 34…”

“…However, histological diagnosis of LGD is subject to sample error and considerable interobserver variation, mainly because features of dysplasia may overlap with features of non-neoplastic regenerative changes 11. Although the predictive value of LGD increases with consensus of multiple pathologists, still one-third of patients with BO are diagnosed with LGD during surveillance, while the 10-year cumulative incidence of neoplastic progression is only around 15% in this subgroup 12 13. Use of biomarkers in addition to histological assessment may improve risk stratification for these patients, whereby more stringent surveillance is applied to individuals at high risk for neoplastic progression, while surveillance intervals are prolonged in those at low risk.…”

Risk of malignant progression in patients with Barrett's oesophagus: a Dutch nationwide cohort study

“…This was consistent with other studies 35–41. It is likely that an even better accuracy of risk prediction may be achieved by a consensus LGD diagnosis of more than one pathologist 37 40. In addition, the extent of the spread of LGD has been suggested to be another significant risk factor for the development of OAC 42…”

Barrett's oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel

“…Most previously reported κ values range from 0.14 to 0.32, which can be classified as poor to fair agreement 10 12 21–24. Only a minority of studies reported moderate to good agreements between GI pathologists with a special interest in BO, with κ scores ranging from 0.48 to 0.69 11 13 25 26.…”