Surveillance in Barrett's esophagus relies on the detection of dysplasia by histopathology.
However, the natural history of this condition, particularly that of low-grade dysplasia is poorly understood.
Dr Lim and colleagues from England describe their experience of low-grade dysplasia over a period of 21 years.
|Cancer developed in 27% of patients with low-grade dysplasia |
The team retrospectively assessed a cohort of 357 patients with Barrett's esophagus without dysplasia for annual surveillance between 1984 and 1995.
The team evaluated survival and cancer outcomes 8 years after the original diagnosis of low-grade dysplasia .
Of these patients, 34 developed low-grade dysplasia during this period.
The team compared these with patients who did not develop low-grade dysplasia over the same period.
In addition, the team performed a histopathological review of the original diagnoses of low-grade dysplasia .
The researchers found that after 8 years, high-grade dysplasia or cancer had developed in 27% of patients with low-grade dysplasia and in 5% of controls.
The time from the first diagnosis of Barrett's esophagus to the first ‘event' of either high-grade dysplasia, esophageal cancer, or death did not show a significant difference between the 2 groups.
A further analysis treating death as ‘loss to follow-up' showed an increased risk for the low-grade dysplasia group to progress to high-grade dysplasia or cancer.
The histopathology review demonstrated a fair level of agreement between pathologists, with a kappa value of about 0.5.
Dr Lim's team concluded, "Patients diagnosed with low-grade dysplasia during surveillance of Barrett's esophagus are at a considerably increased risk of progressing to develop esophageal cancer over an 8-year period but most deaths are not cancer-related."