title: Barrett's Adenocarcinomas are frequently underdiagnosed as "high grade intraepithelial neoplasia".
abstract: BACKGROUND
  Relevant guidelines require that a primary histological diagnosis of high-grade intraepithelial neoplasia (HGIEN) in Barrett's oesophagus, be submitted to a second opinion by an expert gastroenterological pathologist. To date, however, no pertinent study of the outcome of such second-opinion diagnoses has been published.
  
  
  METHODS
  Between 2001 and 2005, histological slides from 275 patients with the primary diagnosis HGIEN underwent a second-opinion review. The resulting diagnoses were checked by follow-up in 207 of these patients (75.3 %).
  
  
  RESULTS
  The second-opinion diagnosis no IEN (n = 27) was confirmed in 85.2 % of the cases, 7.4 % had LGIEN, 3.7 % had HGIEN or a well-differentiated Barrett's adenocarcinoma (BCA) (1 patient, each). In the single patient with the second-opinion diagnosis LGIEN, endoscopic resection revealed a well-differentiated BCA, Follow-up examinations confirmed the second-opinion diagnosis BCA in 5 out of 12 patients, in 1 patient no IEN was found, and 6 patients had a BCA. The second-opinion diagnosis BCA was confirmed by follow-up-examinations in 145 patients (86.8 %), in 12 patients (7.2 %) follow-up revealed HGIEN and in 10 no neoplasia.
  
  
  CONCLUSIONS
  The results of this study show that the demand for a second opinion from an expert gastroenterological pathologist is justified, and also that BCA is frequently underdiagnosed as HGIEN.
authors.affiliation: Institut für Pathologie, Klinikum Kulmbach, Bayreuth, Germany. prof.m.stolte@t-online.de
authors.forename: M
authors.initials: M
authors.lastname: Stolte
authors.forename: J
authors.initials: J
authors.lastname: Benicke
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology*; D000368:Aged; D001471:Barrett Esophagus / Q000453:epidemiology* / Q000473:pathology*; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000473:pathology; D015897:Comorbidity; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D005188:False Negative Reactions; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D015588:Observer Variation; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity