Low-grade dysplasia in Barrett’s esophagus is overdiagnosed.
Studies have shown that Barrett’s mucosa with low-grade dysplasia
is significantly over-diagnosed. In one study, 12.2% of Barrett’s
patients were diagnosed with low-grade dysplasia. However, only 1.8% of
all Barrett’s biopsies were confirmed as truly dysplastic by a pathologist
with expertise in gastrointestinal pathology. (See figure.)
At Inform Diagnostics, our expert GI pathologists diagnose low-grade
dysplasia in 1.9% of all Barrett’s cases. This correlates almost
exactly with the rate of low-grade dysplasia confirmed by other expert
GI pathologists in the study.
Why does it matter?
The American Gastroenterological Association (AGA) recommends the following
surveillance intervals for Barrett’s patients:
- No dysplasia: 3–5 years.
- Low-grade dysplasia: 6–12 months.
Following AGA guidelines in the context of the study above would result
in a three- to tenfold increase in follow-up and treatment costs when
compared with the rate of expert diagnosis of low-grade dysplasia in Barrett’s
esophagus. Moreover, the study data did not include the category of “indefinite
for dysplasia,” a diagnosis that should be followed in the same
way as LGD, and that also
may be overdiagnosed (Inform Diagnostics’s “indefinite for dysplasia”
rate is 2%).
Hahm GK, Niemann TH, Lucas, JG, and Frankel WL. The Value of Second Opinion
in Gastrointestinal and Liver Pathology.
Archives of Pathology & Laboratory Medicine 2001;125(6):736-39.
Curvers WL, et al. Low-grade dysplasia in Barrett’s esophagus: overdiagnosed
American Journal of Gastroenterology 2010;105:1523-30.
American Gastroenterological Association medical position statement on
the management of Barrett’s esophagus.