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Expert Pathology Panel Better at Diagnosing Low-Grade Dysplasia With Barrett's

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  • Expert Pathology Panel Better at Diagnosing Low-Grade Dysplasia With Barrett's

    Expert Pathology Panel Better at Diagnosing Low-Grade Dysplasia With Barrett's Esophagus

    By Will Boggs MD
    July 30, 2014

    NEW YORK (Reuters Health) - Expert pathology panels are better than community pathologists at diagnosing low-grade dysplasia (LGD) in association with Barrett's esophagus, researchers from the Netherlands report.

    "We believe that all LGD diagnoses should be reviewed by an expert panel of pathologists," Dr. Jacques J. G. H. M. Bergman from Academic Medical Centre Amsterdam told Reuters Health by email. "Community pathologists are generally confident in making a diagnosis in the lower (non-dysplastic Barrett's) and upper end of the spectrum (high-grade dysplasia and carcinoma). We know, however, that LGD in Barrett's esophagus can be a challenging histological diagnosis."

    It's important to get the diagnosis right, because low-grade dysplasia demands intensified endoscopic surveillance every 6 to 12 months or possibly endoscopic therapy, whereas non-dysplastic Barrett's esophagus requires surveillance only every 3 to 5 years.

    Dr. Bergman and colleagues sought to determine the value of an expert pathology panel organized in the Dutch Barrett's Advisory Committee by investigating the incidence rates of high-grade dysplasia and esophageal adenocarcinoma after expert histological review of LGD diagnoses.

    Their retrospective cohort study included 293 patients referred with a community diagnosis of LGD.

    The revised diagnoses of the expert panel left only 79 patients (27%) with a diagnosis of LGD. Most patients (174, 59%) were downgraded to non-dysplastic Barrett's esophagus, and the rest (40, 14%) received a diagnosis of "indefinite for dysplasia" (IND), according to the July 17 Gut online report.

    Just over a quarter of the patients diagnosed by the panel with LGD (21/79, 27%) experienced neoplastic progression during endoscopic follow-up (median time to progression, 16 months). The cumulative incidence of progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EA) was 33.3% in 5 years.

    Far fewer patients with a diagnosis downgraded to non-dysplastic Barrett's esophagus or IND (5/214, 2%) progressed to HGD/EA, and their median time to progression was longer (46 months).

    The 5-year cumulative incidence of progression to HGD/EA was much lower in those with non-dysplastic Barrett's esophagus (2.1%) and in the group diagnosed as IND (2.9%).

    "The turnaround time is indeed a bit longer when reviewing LGD biopsies by an expert panel," Dr. Bergman said. "This is, however, not much of a disadvantage since there is enough time to make a treatment/surveillance decision in Barrett's LGD."

    "To overcome this issue we are developing a web-based histology revision platform, in order to facilitate simultaneous histology review by multiple expert pathologists throughout the country," he said. "This will reduce the turnaround time. Furthermore, such a web-based platform can facilitate consensus meetings without the need for a face-to-face meeting with all pathologists in the panel."

    Dr. Giovanni Zaninotto from Imperial College London in the UK recently reviewed the issue of surveillance for LGD associated with Barrett's esophagus. He told Reuters Health by email, "The variability of diagnosis in LGD is very high and there is now evidence (confirmed in this article) that if LGD is really LGD (and not a misinterpretation because of inflammation or other) the risk of progression is high."

    "There is a consensus that all dysplastic Barrett (HGD, LGD, and IND) should be reviewed by a second expert pathologist," Dr. Zaninotto said. "The treatment of LGD (when confirmed) should be more aggressive and endoscopic ablative therapy (radio frequency ablation) expanded to these lesions."


    Gut 2014.

    Reuters Health Information © 2014

    Cite this article: Expert Pathology Panel Better at Diagnosing Low-Grade Dysplasia With Barrett's Esophagus. Medscape. Jul 29, 2014.