Progression from low-grade dysplasia to malignancy in patients with Barrett's esophagus diagnosed by two or more pathologists.
OBJECTIVE
To evaluate annual incidence of low grade dysplasia (LGD) progression to high grade dysplasia (HGD) and/or esophageal adenocarcinoma (EAC) when diagnosis was made by two or more expert pathologists.


METHODS
Studies evaluating the progression of LGD to HGD or EAC were included. The diagnosis of LGD must be made by consensus of two or more expert gastrointestinal pathologists. Articles were searched in Medline, Pubmed, and Embase. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using theI2statistic.


RESULTS
Initial search identified 721 reference articles, of which 53 were selected and reviewed. Twelve studies (n= 971) that met the inclusion criteria were included in this analysis. Among the total original LGD diagnoses in the included studies, only 37.49% reached the consensus LGD diagnosis after review by two or more expert pathologists. Total follow up period was 1532 patient-years. In the pooled consensus LGD patients, the annual incidence rate (AIR) of progression to HGD and or EAC was 10.35% (95%CI: 7.56-13.13) and progression to EAC was 5.18% (95%CI: 3.43-6.92). Among the patients down staged from original LGD diagnosis to No-dysplasia Barrett's esophagus, the AIR of progression to HGD and EAC was 0.65% (95%CI: 0.49-0.80). Among the patients down staged to Indefinite for dysplasia, the AIR of progression to HGD and EAC was 1.42% (95%CI: 1.19-1.65). In patients with consensus HGD diagnosis, the AIR of progression to EAC was 28.63% (95%CI: 13.98-43.27).


CONCLUSIONS
When LGD is diagnosed by consensus agreement of two or more expert pathologists, its progression towards malignancy seems to be at least three times the current estimates, however it could be up to 20 times the current estimates. Biopsies of all Barrett's esophagus patients with LGD should be reviewed by two expert gastroenterology pathologists. Follow-up strict surveillance programs should be in place for these patients.
Harsha Moole, Jaymon Patel, Zohair Ahmed, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Harsha
H
Moole
Harsha Moole, Jaymon Patel, Zohair Ahmed, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Jaymon
J
Patel
Harsha Moole, Jaymon Patel, Zohair Ahmed, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Zohair
Z
Ahmed
Harsha Moole, Jaymon Patel, Zohair Ahmed, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Abhiram
A
Duvvuri
Harsha Moole, Jaymon Patel, Zohair Ahmed, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Sreekar
S
Vennelaganti
Harsha Moole, Jaymon Patel, Zohair Ahmed, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Vishnu
V
Moole
Harsha Moole, Jaymon Patel, Zohair Ahmed, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Sowmya
S
Dharmapuri
Harsha Moole, Jaymon Patel, Zohair Ahmed, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Raghuveer
R
Boddireddy
Harsha Moole, Jaymon Patel, Zohair Ahmed, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Pratyusha
P
Yedama
Harsha Moole, Jaymon Patel, Zohair Ahmed, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Naveen
N
Bondalapati
Harsha Moole, Jaymon Patel, Zohair Ahmed, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Achuta
A
Uppu
Harsha Moole, Jaymon Patel, Zohair Ahmed, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Prashanth
P
Vennelaganti
Harsha Moole, Jaymon Patel, Zohair Ahmed, Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Srinivas
S
Puli
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000368:Aged; D001471:Barrett Esophagus / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D000072142:Pathologists; D011230:Precancerous Conditions / Q000473:pathology
Annual incidence of progression; Barrett’s esophagus; Esophageal adenocarcinoma; High grade dysplasia; Low grade dysplasia; Meta-analysis; Systematic review