Low-grade dysplasia in Barrett's esophagus: overdiagnosed and underestimated

Am J Gastroenterol. 2010 Jul;105(7):1523-30. doi: 10.1038/ajg.2010.171. Epub 2010 May 11.

Abstract

Objectives: Published data on the natural history of low-grade dysplasia (LGD) in Barrett's esophagus (BE) are inconsistent and difficult to interpret. We investigated the natural history of LGD in a large community-based cohort of BE patients after reviewing the original histological diagnosis by an expert panel of pathologists.

Methods: Histopathology reports of all patients diagnosed with LGD between 2000 and 2006 in six non-university hospitals were reviewed by two expert pathologists. This panel diagnosis was subsequently compared with the histological outcome during prospective endoscopic follow-up.

Results: A diagnosis of LGD was made in 147 patients. After pathology review, 85% of the patients were downstaged to non-dysplastic BE (NDBE) or to indefinite for dysplasia. In only 15% of the patients was the initial diagnosis LGD. Endoscopic follow-up was carried out in 83.6% of patients, with a mean follow-up of 51.1 months. For patients with a consensus diagnosis of LGD, the cumulative risk of progressing to high-grade dysplasia or carcinoma (HGD or Ca) was 85.0% in 109.1 months compared with 4.6% in 107.4 months for patients downstaged to NDBE (P<0.0001). The incidence rate of HGD or Ca was 13.4% per patient per year for patients in whom the diagnosis of LGD was confirmed. For patients downstaged to NDBE, the corresponding incidence rate was 0.49%.

Conclusions: LGD in BE is an overdiagnosed and yet underestimated entity in general practice. Patients diagnosed with LGD should undergo an expert pathology review to purify this group. In case the diagnosis of LGD is confirmed, patients should undergo strict endoscopic follow-up or should be considered for endoscopic ablation therapy.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Barrett Esophagus / epidemiology
  • Barrett Esophagus / pathology*
  • Disease Progression
  • Esophageal Neoplasms / epidemiology
  • Esophageal Neoplasms / pathology
  • Esophagoscopy
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Population Surveillance
  • Precancerous Conditions / epidemiology
  • Precancerous Conditions / pathology*
  • Prospective Studies
  • Registries
  • Retrospective Studies
  • Risk Assessment