Low-grade Dysplasia in Barrett’s Esophagus: A Difficult Diagnosis Best Handled by Experts
Low-grade dysplasia in Barrett’s esophagus is overdiagnosed.
Studies have shown that Barrett’s mucosa with low-grade dysplasia is significantly over-diagnosed.1 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.2 (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 intervals3 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%).
1 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.
2 Curvers WL, et al. Low-grade dysplasia in Barrett’s esophagus: overdiagnosed and underestimated. American Journal of Gastroenterology 2010;105:1523-30.
3 American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology 2011;140(3):1084-91.