title: The significance of "indefinite for dysplasia" grading in Barrett metaplasia.
abstract: BACKGROUND
  For a confident diagnosis of dysplasia in Barrett metaplasia, the epithelial atypia should also involve the surface epithelium. However, pathologists are often faced with biopsies where the crypts show dysplasia, but the surface epithelium is either uninvolved or unevaluable. We previously grouped these cases with indefinite for dysplasia (IND).
  
  
  OBJECTIVE
  To determine the clinical significance of IND grading in Barrett metaplasia.
  
  
  METHODS
  All biopsies from 276 prospectively followed patients with Barrett metaplasia, who did not have high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) on initial biopsy, were graded as negative for dysplasia, IND, low-grade dysplasia (LGD), HGD, and EAC. Biopsies with multifocal IND or LGD were graded as INDM or LGDM, respectively.
  
  
  RESULTS
  Only 3 of 193 patients (2%) with an initial diagnosis of negative for dysplasia and only 1 of 48 patients (2%) diagnosed with IND progressed to HGD or EAC. By contrast, 1 of 7 patients (14%) with INDM, 2 of 21 (10%) with LGD, and 1 of 7 (14%) with LGDM progressed to HGD or EAC. There was no significant difference in progression rate between patients with an initial diagnosis of negative for dysplasia and those diagnosed IND nor were there significant differences among patients with initial diagnoses of INDM, LGD, or LGDM. Kaplan-Meier analysis showed that patients with INDM, LGD, or LGDM on initial biopsy (group 1) were more likely to progress to HGD or EAC than were those patients who were diagnosed negative for dysplasia or IND (group 2; log-rank test, P < .001).
  
  
  CONCLUSIONS
  Multifocal IND in an esophageal biopsy from a patient with Barrett metaplasia has the same clinical implication as LGD.
authors.affiliation: Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, USA. myounes@bcm.edu
authors.forename: Mamoun
authors.initials: M
authors.lastname: Younes
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: Atilla
authors.initials: A
authors.lastname: Ertan
authors.forename: Gulchin
authors.initials: G
authors.lastname: Ergun
authors.forename: Ray
authors.initials: R
authors.lastname: Verm
authors.forename: Margaret
authors.initials: M
authors.lastname: Bridges
authors.forename: Karen
authors.initials: K
authors.lastname: Woods
authors.forename: Frank
authors.initials: F
authors.lastname: Meriano
authors.forename: Carl
authors.initials: C
authors.lastname: Schmulen
authors.forename: Craig
authors.initials: C
authors.lastname: Johnson
authors.forename: Alberto
authors.initials: A
authors.lastname: Barroso
authors.forename: Jim
authors.initials: J
authors.lastname: Schwartz
authors.forename: John
authors.initials: J
authors.lastname: McKechnie
authors.forename: Juan
authors.initials: J
authors.lastname: Lechago
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D001471:Barrett Esophagus / Q000175:diagnosis*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D004947:Esophagus / Q000473:pathology*; D006801:Humans; D011230:Precancerous Conditions / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies