For patients with Barrett’s esophagus, the diagnosis of low-grade dysplasia is subjective, and reported outcomes vary.
Dr Jacques Bergman and colleagues from the Netherlands analyzed data from a multicenter study of endoscopic therapy to identify factors associated with progression to high-grade dysplasia or esophageal adenocarcinoma in patients with low-grade dysplasia of the esophagus.
The researchers performed a retrospective analysis of data from 255 patients with a primary diagnosis of low-grade dysplasia who participated in a randomized controlled trial of surveillance vs radiofrequency ablation in Europe.
The were 3 expert pathologists that independently reviewed baseline, and subsequent low-grade dysplasia specimens.
The presence and degree of dysplasia was separately recorded for each biopsy and classified according to the Vienna Classification system.
|18% developed high-grade dysplasia or esophageal adenocarcinoma|
The team's primary end point was development of high-grade dysplasia or esophageal adenocarcinoma.
The researchers assessed the association between outcomes and factors such as number of pathologists confirming low-grade dysplasia, multifocality of low-grade dysplasia, and persistence of low-grade dysplasia over time.
Of the 255 patients, the team found that 18% developed high-grade dysplasia or esophageal adenocarcinoma during a median 42-month follow-up period.
Patients were examined by a median 4 endoscopies.
The team noted that the number of pathologists confirming low-grade dysplasia was strongly associated with progression to neoplasia.
Risk for progression increased greatly when all 3 pathologists agreed on low-grade dysplasia.
When low-grade dysplasia was detected at baseline and confirmed by a subsequent endoscopy, the odds for progression to neoplasia also increased greatly.
The researchers observed that multifocal low-grade dysplasia was not significantly associated with progression to neoplasia.
Dr Bergman's team comments, "The number of pathologists confirming low-grade dysplasia and persistence of low-grade dysplasia over time increase risk for development of high-grade dysplasia or esophageal adenocarcinoma in patients with Barrett’s esophagus and low-grade dysplasia."
"These simple, readily available variables can help stratify risk, and select patients for prophylactic ablation therapy."