title: Barrett's oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel.
abstract: OBJECTIVE
  Reported malignant progression rates for low-grade dysplasia (LGD) in Barrett's oesophagus (BO) vary widely. Expert histological review of LGD is advised, but limited data are available on its clinical value. This retrospective cohort study aimed to determine the value of an expert pathology panel organised in the Dutch Barrett's Advisory Committee (BAC) by investigating the incidence rates of high-grade dysplasia (HGD) and oesophageal adenocarcinoma (OAC) after expert histological review of LGD.
  
  
  METHODS
  We included all BO cases referred to the BAC for histological review of LGD diagnosed between 2000 and 2011. The diagnosis of the expert panel was related to the histological outcome during endoscopic follow-up. Primary endpoint was development of HGD or OAC.
  
  
  RESULTS
  293 LGD patients (76% men; mean 63 years±11.9) were included. Following histological review, 73% was downstaged to non-dysplastic BO (NDBO) or indefinite for dysplasia (IND). In 27% the initial LGD diagnosis was confirmed. Endoscopic follow-up was performed in 264 patients (90%) with a median follow-up of 39 months (IQR 16-72). For confirmed LGD, the risk of HGD/OAC was 9.1% per patient-year. Patients downstaged to NDBO or IND had a malignant progression risk of 0.6% and 0.9% per patient-year, respectively.
  
  
  CONCLUSIONS
  Confirmed LGD in BO has a markedly increased risk of malignant progression. However, the vast majority of patients with community LGD will be downstaged after expert review and have a low progression risk. Therefore, all BO patients with LGD should undergo expert histological review of the diagnosis for adequate risk stratification.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Lucas C
authors.initials: LC
authors.lastname: Duits
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: K Nadine
authors.initials: KN
authors.lastname: Phoa
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Wouter L
authors.initials: WL
authors.lastname: Curvers
authors.affiliation: Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands Department of Pathology, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Fiebo J W
authors.initials: FJ
authors.lastname: Ten Kate
authors.affiliation: Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Gerrit A
authors.initials: GA
authors.lastname: Meijer
authors.affiliation: Department of Pathology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Cees A
authors.initials: CA
authors.lastname: Seldenrijk
authors.affiliation: Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands Department of Pathology, University Medical Centre, Utrecht, The Netherlands.
authors.forename: G Johan
authors.initials: GJ
authors.lastname: Offerhaus
authors.affiliation: Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Mike
authors.initials: M
authors.lastname: Visser
authors.affiliation: Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Sybren L
authors.initials: SL
authors.lastname: Meijer
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Kausilia K
authors.initials: KK
authors.lastname: Krishnadath
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands Department of Gastroenterology and Hepatology, Flevoziekenhuis, Almere, The Netherlands.
authors.forename: Rosalie C
authors.initials: RC
authors.lastname: Mallant-Hent
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Jacques J G H M
authors.initials: JJ
authors.lastname: Bergman
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods
keywords: Barrett's Carcinoma; Barrett's Oesophagus; Dysplasia; Histopathology; Oesophageal Cancer