Refined Criteria for Separating Low-grade Dysplasia and Nondysplastic Barrett Esophagus Reduce Equivocal Diagnoses and Improve Prediction of Patient Outcome

Research output: Contribution to journalArticle

Abstract

The indefinite for dysplasia (IFD) category in Barrett esophagus (BE) is used for biopsies that are neither unequivocally dysplastic nor negative for dysplasia (NFD). In 2012, we refined our criteria so that BE with maintained cell polarity and surface gastric-Type mucin vacuoles is considered NFD even with mild to moderate nuclear enlargement. A total of 1549 cases from 1130 patients with BE biopsies were identified from 2007 to 2016. Follow-up on patients with IFD biopsies was obtained to learn if the new thresholds better defined risk of progression. The earlier cases (2007-2011) were less likely than later cases (2012-2016) to be NFD (84.0% vs. 90.4%) and more likely to be IFD (8.4% vs. 4.3%). The proportions of low-grade dysplasia (3.9% vs. 2.5%, high-grade dysplasia (1.4% vs. 1.3%), and intramucosal carcinoma (2.3% vs. 1.6%) were similar between the earlier and later cases, respectively. Later IFD cases were more frequently dysplastic (3/21, 14.3%) on the next biopsy than earlier cases (1/48, 2.1%). The rate of dysplasia on the next biopsy for NFD cases was not higher in the later cases (6/222, 2.7%) than the earlier cases (16/360, 4.4%). Improved diagnostic criteria reduced the proportion of IFD cases by nearly 50% from 2007 to 2016. This change coincided with a higher proportion of IFD cases having dysplasia on the next biopsy. NFD patients had no increase in dysplasia on the next biopsy providing evidence that dysplastic cases are not missed by the refined criteria. ©

Original languageEnglish (US)
Pages (from-to)1723-1729
Number of pages7
JournalAmerican Journal of Surgical Pathology
Volume42
Issue number12
DOIs
StatePublished - Dec 1 2018

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Barrett Esophagus
Biopsy
Gastric Mucins
Cell Polarity
Vacuoles
Carcinoma

Keywords

  • Barrett esophagus
  • dysplasia
  • esophageal adenocarcinoma
  • goblet cells
  • intestinal metaplasia

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

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title = "Refined Criteria for Separating Low-grade Dysplasia and Nondysplastic Barrett Esophagus Reduce Equivocal Diagnoses and Improve Prediction of Patient Outcome",
abstract = "The indefinite for dysplasia (IFD) category in Barrett esophagus (BE) is used for biopsies that are neither unequivocally dysplastic nor negative for dysplasia (NFD). In 2012, we refined our criteria so that BE with maintained cell polarity and surface gastric-Type mucin vacuoles is considered NFD even with mild to moderate nuclear enlargement. A total of 1549 cases from 1130 patients with BE biopsies were identified from 2007 to 2016. Follow-up on patients with IFD biopsies was obtained to learn if the new thresholds better defined risk of progression. The earlier cases (2007-2011) were less likely than later cases (2012-2016) to be NFD (84.0{\%} vs. 90.4{\%}) and more likely to be IFD (8.4{\%} vs. 4.3{\%}). The proportions of low-grade dysplasia (3.9{\%} vs. 2.5{\%}, high-grade dysplasia (1.4{\%} vs. 1.3{\%}), and intramucosal carcinoma (2.3{\%} vs. 1.6{\%}) were similar between the earlier and later cases, respectively. Later IFD cases were more frequently dysplastic (3/21, 14.3{\%}) on the next biopsy than earlier cases (1/48, 2.1{\%}). The rate of dysplasia on the next biopsy for NFD cases was not higher in the later cases (6/222, 2.7{\%}) than the earlier cases (16/360, 4.4{\%}). Improved diagnostic criteria reduced the proportion of IFD cases by nearly 50{\%} from 2007 to 2016. This change coincided with a higher proportion of IFD cases having dysplasia on the next biopsy. NFD patients had no increase in dysplasia on the next biopsy providing evidence that dysplastic cases are not missed by the refined criteria. {\circledC}",
keywords = "Barrett esophagus, dysplasia, esophageal adenocarcinoma, goblet cells, intestinal metaplasia",
author = "Waters, {Kevin M.} and Kevan Salimian and Lysandra Voltaggio and Montgomery, {Elizabeth A}",
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T1 - Refined Criteria for Separating Low-grade Dysplasia and Nondysplastic Barrett Esophagus Reduce Equivocal Diagnoses and Improve Prediction of Patient Outcome

AU - Waters, Kevin M.

AU - Salimian, Kevan

AU - Voltaggio, Lysandra

AU - Montgomery, Elizabeth A

PY - 2018/12/1

Y1 - 2018/12/1

N2 - The indefinite for dysplasia (IFD) category in Barrett esophagus (BE) is used for biopsies that are neither unequivocally dysplastic nor negative for dysplasia (NFD). In 2012, we refined our criteria so that BE with maintained cell polarity and surface gastric-Type mucin vacuoles is considered NFD even with mild to moderate nuclear enlargement. A total of 1549 cases from 1130 patients with BE biopsies were identified from 2007 to 2016. Follow-up on patients with IFD biopsies was obtained to learn if the new thresholds better defined risk of progression. The earlier cases (2007-2011) were less likely than later cases (2012-2016) to be NFD (84.0% vs. 90.4%) and more likely to be IFD (8.4% vs. 4.3%). The proportions of low-grade dysplasia (3.9% vs. 2.5%, high-grade dysplasia (1.4% vs. 1.3%), and intramucosal carcinoma (2.3% vs. 1.6%) were similar between the earlier and later cases, respectively. Later IFD cases were more frequently dysplastic (3/21, 14.3%) on the next biopsy than earlier cases (1/48, 2.1%). The rate of dysplasia on the next biopsy for NFD cases was not higher in the later cases (6/222, 2.7%) than the earlier cases (16/360, 4.4%). Improved diagnostic criteria reduced the proportion of IFD cases by nearly 50% from 2007 to 2016. This change coincided with a higher proportion of IFD cases having dysplasia on the next biopsy. NFD patients had no increase in dysplasia on the next biopsy providing evidence that dysplastic cases are not missed by the refined criteria. ©

AB - The indefinite for dysplasia (IFD) category in Barrett esophagus (BE) is used for biopsies that are neither unequivocally dysplastic nor negative for dysplasia (NFD). In 2012, we refined our criteria so that BE with maintained cell polarity and surface gastric-Type mucin vacuoles is considered NFD even with mild to moderate nuclear enlargement. A total of 1549 cases from 1130 patients with BE biopsies were identified from 2007 to 2016. Follow-up on patients with IFD biopsies was obtained to learn if the new thresholds better defined risk of progression. The earlier cases (2007-2011) were less likely than later cases (2012-2016) to be NFD (84.0% vs. 90.4%) and more likely to be IFD (8.4% vs. 4.3%). The proportions of low-grade dysplasia (3.9% vs. 2.5%, high-grade dysplasia (1.4% vs. 1.3%), and intramucosal carcinoma (2.3% vs. 1.6%) were similar between the earlier and later cases, respectively. Later IFD cases were more frequently dysplastic (3/21, 14.3%) on the next biopsy than earlier cases (1/48, 2.1%). The rate of dysplasia on the next biopsy for NFD cases was not higher in the later cases (6/222, 2.7%) than the earlier cases (16/360, 4.4%). Improved diagnostic criteria reduced the proportion of IFD cases by nearly 50% from 2007 to 2016. This change coincided with a higher proportion of IFD cases having dysplasia on the next biopsy. NFD patients had no increase in dysplasia on the next biopsy providing evidence that dysplastic cases are not missed by the refined criteria. ©

KW - Barrett esophagus

KW - dysplasia

KW - esophageal adenocarcinoma

KW - goblet cells

KW - intestinal metaplasia

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JO - American Journal of Surgical Pathology

JF - American Journal of Surgical Pathology

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