title: The importance of a second opinion in the diagnosis of Barrett's esophagus: a "real life" study.
abstract: BACKGROUND
  Barrett's esophagus is a precancerous lesion, and its identification with the early detection of dysplasia is of paramount importance to prevent adenocarcinoma onset. However, there is still debate on the correct pathological identification of Barrett's esophagus (and of associated dysplasia), and most studies have been conducted in an experimental setting.
  
  
  OBJECTIVE
  To assess previous uncertain diagnoses of Barrett's (with and without dysplasia) via a second opinion of an expert pathologist in a real life setting.
  
  
  METHODS
  Histological sections of 32 suspected Barrett's patients from ten general Pathology units were centralized into one single unit in which an expert pathologist reviewed the slides blindly.
  
  
  RESULTS
  Overall, in 78% of cases there was diagnostic discordance; in particular, in 64% of cases the presence of low grade dysplasia was not confirmed. Of interest, 28% of cases with the original diagnosis were reclassified as non-Barrett's.
  
  
  CONCLUSIONS
  The pathological diagnosis of Barrett's esophagus, especially with regard to the presence of dysplasia, is still misinterpreted, particularly in the setting of general Pathology units. Thus, a second opinion from an experienced pathologist may help in the interpretation of the results and in starting appropriate follow-up programs.
authors.affiliation: Institute of Pathology. Spedali Civili. Brescia, I, Pathology.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Villanacci
authors.affiliation: Institute of Pathology. Spedali Civili. Brescia, I, Pathology.
authors.forename: Marianna
authors.initials: M
authors.lastname: Salemme
authors.affiliation: Tor Vergata University Hospital. Roma, Italy, Endoscopy Unit.
authors.forename: Italo
authors.initials: I
authors.lastname: Stroppa
authors.affiliation: Tor Vergata University Hospital. Roma, Italy, Endoscopy Unit.
authors.forename: Valerio
authors.initials: V
authors.lastname: Balassone
authors.affiliation: University of Perugia Medical School. Perugia, Ita, GI Section, Italia.
authors.forename: Gabrio
authors.initials: G
authors.lastname: Bassotti
mesh_terms: D001471:Barrett Esophagus / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation