title: Consistency of a high-grade dysplasia diagnosis in Barrett's oesophagus: a Dutch nationwide cohort study.
abstract: BACKGROUND
  Consistency of high-grade dysplasia in Barrett's oesophagus is incompletely known and the clinical course may vary between patients.
  
  
  OBJECTIVE
  To evaluate the consistency of high-grade dysplasia diagnosis in a Dutch nationwide cohort and to identify predictors for (re-)detecting high-grade dysplasia or oesophageal adenocarcinoma when ≥ 1 follow-up evaluations after an initial high-grade dysplasia diagnosis were scored with a lower histological grade.
  
  
  METHODS
  In this retrospective cohort study, all patients diagnosed with high-grade dysplasia in Barrett's oesophagus between 1999 and 2008 in the Netherlands were selected using the nationwide histopathology registry. Multivariate analysis was performed to identify predictors for (re-)detecting high-grade dysplasia or oesophageal adenocarcinoma in patients with ≥ 1 follow-up evaluations scored with a lower grade.
  
  
  RESULTS
  In total, 512 high-grade dysplasia patients were included, of whom 53% had ≥ 1 follow-up evaluations scored with a lower grade. The (re-)detection risk was increased when follow-up was performed in a university hospital and when endoscopic/surgical resection was performed and decreased with an increasing number of follow-up evaluations scored with a lower grade.
  
  
  CONCLUSIONS
  High-grade dysplasia diagnosis was inconsistent in more than half of patients. (Endoscopic) resection in an expert centre is recommended to (re-)detect high-grade dysplasia or oesophageal adenocarcinoma when an endoscopic follow-up protocol with biopsies repeatedly shows a lower histological grade.
authors.affiliation: Departments of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: r.e.verbeek-2@umcutrecht.nl.
authors.forename: Romy E
authors.initials: RE
authors.lastname: Verbeek
authors.affiliation: Departments of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Martijn G H
authors.initials: MG
authors.lastname: van Oijen
authors.affiliation: Departments of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Fiebo J
authors.initials: FJ
authors.lastname: ten Kate
authors.affiliation: Departments of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Vleggaar
authors.affiliation: Departments of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Jantine W P M
authors.initials: JW
authors.lastname: van Baal
authors.affiliation: Departments of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy; D015331:Cohort Studies; D018450:Disease Progression; D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009426:Netherlands; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk
keywords: Barrett's oesophagus; Consistency; Diagnosis; High-grade dysplasia