Low-grade dysplasia in Barrett's esophagus: overdiagnosed and underestimated.
OBJECTIVE
Published data on the natural history of low-grade dysplasia (LGD) in Barrett's esophagus (BE) are inconsistent and difficult to interpret. We investigated the natural history of LGD in a large community-based cohort of BE patients after reviewing the original histological diagnosis by an expert panel of pathologists.


METHODS
Histopathology reports of all patients diagnosed with LGD between 2000 and 2006 in six non-university hospitals were reviewed by two expert pathologists. This panel diagnosis was subsequently compared with the histological outcome during prospective endoscopic follow-up.


RESULTS
A diagnosis of LGD was made in 147 patients. After pathology review, 85% of the patients were downstaged to non-dysplastic BE (NDBE) or to indefinite for dysplasia. In only 15% of the patients was the initial diagnosis LGD. Endoscopic follow-up was carried out in 83.6% of patients, with a mean follow-up of 51.1 months. For patients with a consensus diagnosis of LGD, the cumulative risk of progressing to high-grade dysplasia or carcinoma (HGD or Ca) was 85.0% in 109.1 months compared with 4.6% in 107.4 months for patients downstaged to NDBE (P<0.0001). The incidence rate of HGD or Ca was 13.4% per patient per year for patients in whom the diagnosis of LGD was confirmed. For patients downstaged to NDBE, the corresponding incidence rate was 0.49%.


CONCLUSIONS
LGD in BE is an overdiagnosed and yet underestimated entity in general practice. Patients diagnosed with LGD should undergo an expert pathology review to purify this group. In case the diagnosis of LGD is confirmed, patients should undergo strict endoscopic follow-up or should be considered for endoscopic ablation therapy.
Curvers
Wouter L
WL
Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9 , Amsterdam 1105 AZ , The Netherlands.
ten Kate
Fiebo J
FJ
Krishnadath
Kausilia K
KK
Visser
Mike
M
Elzer
Brenda
B
Baak
Lubertus C
LC
Bohmer
Clarisse
C
Mallant-Hent
Rosalie C
RC
van Oijen
Arnout
A
Naber
Anton H
AH
Scholten
Pieter
P
Busch
Olivier R
OR
Blaauwgeers
Harriët G T
HG
Meijer
Gerrit A
GA
Bergman
Jacques J G H M
JJ
D001471:Barrett Esophagus / Q000453:epidemiology / Q000473:pathology*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment