Risk factors for progression of low-grade dysplasia in patients with Barrett's esophagus

Sachin Wani, Gary W. Falk, Jane Post, Lisa Yerian, Matthew Hall, Amy Wang, Neil Gupta, Srinivas Gaddam, Mandeep Singh, Vikas Singh, Kengyu Chuang, Vikram Boolchand, Hemanth Gavini, John Kuczynski, Priti Sud, Ajay Bansal, Amit Rastogi, Sharad C. Mathur, Patrick Young, Brooks CashJohn Goldblum, David A. Lieberman, Richard E. Sampliner, Prateek Sharma

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163 Scopus citations

Abstract

Background & Aims: Data vary on the progression of low-grade dysplasia (LGD) in patients with Barrett's esophagus (BE); in patients with LGD, we investigated the incidence of high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) and compared progression in patients with different forms of LGD (prevalent vs incident and multifocal vs unifocal). We assessed the effects of consensus diagnosis of LGD on progression rates to HGD and EAC among expert pathologists. Methods: In a multicenter outcomes project, 210 patients with BE and LGD (classified as incident, prevalent, or persistent) were included. Patients were followed up for an average of 6.2 years (959.6 patient-years). Persistent LGD was defined as detection of LGD on <2 consecutive occasions during the follow-up period and extent as either unifocal (LGD at one level of BE segment) or multifocal (>1 level). Histology specimens were reviewed by 2 blinded pathologists. Results: Six patients developed EAC (incidence of 0.44%/year), and 21 developed HGD (incidence of 1.6%/year). The incidence of the combination of HGD and EAC was 1.83%/year. There were no associations between presence of prevalent, incident, or persistent LGD and the extent of LGD with progression rates. Based on consensus diagnosis of 88 reviewed specimens, there was no difference in the progression of LGD to either EAC (the incidence based on analyses by the local pathologist was 0.18%/year, the incidence when there was agreement between the local and one central pathologist was 0.21%/year, and the incidence when all 3 pathologists were in agreement was 0.39%/year) or combined HGD and EAC (0.94%/year, 0.87%/year, and 0.84%/year, respectively). Conclusions: Overall, patients with BE and LGD have a low annual incidence of EAC, similar to nondysplastic BE. There are no risk factors for progression and there is significant interobserver variation in diagnosis, even among expert pathologists.

Original languageEnglish (US)
Pages (from-to)1179-1186.e1
JournalGastroenterology
Volume141
Issue number4
DOIs
StatePublished - Oct 2011

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Keywords

  • Cancer
  • Esophagus
  • Natural History
  • Pathology Analysis

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Wani, S., Falk, G. W., Post, J., Yerian, L., Hall, M., Wang, A., Gupta, N., Gaddam, S., Singh, M., Singh, V., Chuang, K., Boolchand, V., Gavini, H., Kuczynski, J., Sud, P., Bansal, A., Rastogi, A., Mathur, S. C., Young, P., ... Sharma, P. (2011). Risk factors for progression of low-grade dysplasia in patients with Barrett's esophagus. Gastroenterology, 141(4), 1179-1186.e1. https://doi.org/10.1053/j.gastro.2011.06.055