title: Oesophageal biopsies are insufficient to predict final histology after endoscopic resection in early Barrett's neoplasia.
abstract: BACKGROUND
  Endoscopic resection (ER) with or without ablation is the first choice treatment for early Barrett's neoplasia. Adequate staging is important to assure a good oncological outcome.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the diagnostic accuracy of pre-operative biopsies in patients who undergo ER for high-grade dysplasia (HGD) or early adenocarcinoma (EAC) in Barrett's oesophagus (BE) and the cardia.
  
  
  METHODS
  Between November 2005-May 2012, 142 ERs performed in 137 patients were obtained. Worst pre-ER and ER histology were compared. Upgrading/downgrading was defined as any more/less severe histological grading on the ER specimen.
  
  
  RESULTS
  The accuracy of pre-ER biopsies in predicting final histology was 61%. ER changed the pre-treatment diagnosis in 55 of the 142 procedures (39%) with downgrading in 23 cases (16%) and upgrading from HGD to T1a or T1b in 32 cases (23%). In the majority of upgraded cases, a visible lesion according to the Paris classification could be detected (26/32, 81%).
  
  
  CONCLUSIONS
  The diagnostic accuracy of oesophageal biopsies alone in predicting final pathology in Barrett's dysplasia is only 61%. The majority of upgraded lesions are detectable. When ablative therapy is considered in HGD Barrett's dysplasia a meticulous inspection for and removal of all small visible lesions is mandatory.
authors.affiliation: Department of General Medical Oncology, KU Leuven and University Hospitals Leuven, Leuven, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Werbrouck
authors.affiliation: Department of Pathology, KU Leuven and University Hospitals Leuven, Leuven, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: De Hertogh
authors.affiliation: Department of Pathology, KU Leuven and University Hospitals Leuven, Leuven, Belgium.
authors.forename: X
authors.initials: X
authors.lastname: Sagaert
authors.affiliation: Department of Gastroenterology, KU Leuven and University Hospitals Leuven, Leuven, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Coremans
authors.affiliation: Department of Gastroenterology, KU Leuven and University Hospitals Leuven, Leuven, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Willekens
authors.affiliation: Department of Gastroenterology, KU Leuven and University Hospitals Leuven, Leuven, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Demedts
authors.affiliation: Department of Gastroenterology, KU Leuven and University Hospitals Leuven, Leuven, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Bisschops
keywords: Accuracy; Barrett; biopsy; histology