Low-Grade Dysplasia in Barrett's Esophagus: Overdiagnosed and Underestimated

被引:351
作者
Curvers, Wouter L. [1 ,12 ]
ten Kate, Fiebo J. [2 ,10 ,12 ]
Krishnadath, Kausilia K. [1 ,12 ]
Visser, Mike [2 ,10 ]
Elzer, Brenda [1 ]
Baak, Lubertus C. [3 ,12 ]
Bohmer, Clarisse [4 ,12 ]
Mallant-Hent, Rosalie C. [5 ,12 ]
van Oijen, Arnout [6 ,12 ]
Naber, Anton H. [7 ,12 ]
Scholten, Pieter [8 ,12 ]
Busch, Olivier R. [9 ,10 ]
Blaauwgeers, Harriet G. T. [10 ]
Meijer, Gerrit A. [10 ,11 ]
Bergman, Jacques J. G. H. M. [1 ,10 ,12 ]
机构
[1] Univ Amsterdam, Acad Med Ctr, Dept Gastroenterol & Hepatol, NL-1105 AZ Amsterdam, Netherlands
[2] Univ Amsterdam, Acad Med Ctr, Dept Pathol, NL-1105 AZ Amsterdam, Netherlands
[3] Onze Lieve Vrouw Hosp, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands
[4] Spaarne Hosp, Dept Gastroenterol & Hepatol, Hoofddorp, Netherlands
[5] Flevohosp, Dept Internal Med, Almere, Netherlands
[6] Med Ctr Alkmaar, Dept Gastroenterol & Hepatol, Alkmaar, Netherlands
[7] Tergooi Hosp, Dept Internal Med, Hilversum, Netherlands
[8] St Lucas Andreas Hosp, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands
[9] Univ Amsterdam, Acad Med Ctr, Dept Surg, NL-1105 AZ Amsterdam, Netherlands
[10] Comprehens Canc Ctr Amsterdam, Barrett Advisory Comm, Amsterdam, Netherlands
[11] Free Univ Amsterdam Hosp, Dept Pathol, Amsterdam, Netherlands
[12] Amsterdam Gastroenterol Assoc, Amsterdam, Netherlands
关键词
CANCER-RISK; INTRAEPITHELIAL NEOPLASIA; ENDOSCOPIC SURVEILLANCE; FOCAL ABLATION; DIAGNOSIS; ADENOCARCINOMA; PROGRESSION; REPRODUCIBILITY; IMMUNOQUANTITATION; PATHOLOGISTS;
D O I
10.1038/ajg.2010.171
中图分类号
R57 [消化系及腹部疾病];
学科分类号
100201 [内科学];
摘要
OBJECTIVES: Published data on the natural history of low-grade dysplasia (LGD) in Barrett's esophagus (BE) are inconsistent and difficult to interpret. We investigated the natural history of LGD in a large community-based cohort of BE patients after reviewing the original histological diagnosis by an expert panel of pathologists. METHODS: Histopathology reports of all patients diagnosed with LGD between 2000 and 2006 in six non-university hospitals were reviewed by two expert pathologists. This panel diagnosis was subsequently compared with the histological outcome during prospective endoscopic follow-up. RESULTS: A diagnosis of LGD was made in 147 patients. After pathology review, 85% of the patients were downstaged to non-dysplastic BE (NDBE) or to indefinite for dysplasia. In only 15% of the patients was the initial diagnosis LGD. Endoscopic follow-up was carried out in 83.6% of patients, with a mean follow-up of 51.1 months. For patients with a consensus diagnosis of LGD, the cumulative risk of progressing to high-grade dysplasia or carcinoma (HGD or Ca) was 85.0% in 109.1 months compared with 4.6% in 107.4 months for patients downstaged to NDBE (P < 0.0001). The incidence rate of HGD or Ca was 13.4% per patient per year for patients in whom the diagnosis of LGD was confirmed. For patients downstaged to NDBE, the corresponding incidence rate was 0.49%. CONCLUSIONS: LGD in BE is an overdiagnosed and yet underestimated entity in general practice. Patients diagnosed with LGD should undergo an expert pathology review to purify this group. In case the diagnosis of LGD is confirmed, patients should undergo strict endoscopic follow-up or should be considered for endoscopic ablation therapy.
引用
收藏
页码:1523 / 1530
页数:8
相关论文
共 48 条
[1]
Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice [J].
Alikhan, M ;
Rex, D ;
Khan, A ;
Rahmani, E ;
Cummings, O ;
Ulbright, TM .
GASTROINTESTINAL ENDOSCOPY, 1999, 50 (01) :23-26
[2]
Routine morphometrical analysis can improve reproducibility of dysplasia grade in Barrett's oesophagus surveilrance biopsies [J].
Baak, JPA ;
ten Kate, FJW ;
Offerhaus, GJA ;
van Lanschot, JJ ;
Meijer, GA .
JOURNAL OF CLINICAL PATHOLOGY, 2002, 55 (12) :910-916
[3]
Casparie M, 2007, CELL ONCOL, V29, P19
[4]
Long-term endoscopic surveillance of patients with Barrett's esophagus.: Incidence of dysplasia and adenocarcinoma:: A prospective study [J].
Conio, M ;
Blanchi, S ;
Lapertosa, G ;
Ferraris, R ;
Sablich, R ;
Marchi, S ;
D'Onofrio, V ;
Lacchin, T ;
Iaquinto, G ;
Missale, G ;
Ravelli, P ;
Cestari, R ;
Benedetti, G ;
Macrì, G ;
Fiocca, R ;
Munizzi, F ;
Filiberti, R .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2003, 98 (09) :1931-1939
[5]
Endoscopic work-up of early Barrett's neoplasia [J].
Curvers, W. L. ;
Bansal, A. ;
Sharma, P. ;
Bergman, J. J. .
ENDOSCOPY, 2008, 40 (12) :1000-1007
[6]
Dysplasia and risk of further neoplastic progression in a regional veterans administration Barrett's cohort [J].
Dulai, GS ;
Shekelle, PG ;
Jensen, DM ;
Spiegel, BMR ;
Chen, J ;
Oh, D ;
Kahn, KL .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2005, 100 (04) :775-783
[7]
Surgical workload and outcome after resection for carcinoma of the oesophagus and cardia [J].
Gillison, EW ;
Powell, J ;
Mcconkey, CC ;
Spychal, RT .
BRITISH JOURNAL OF SURGERY, 2002, 89 (03) :344-348
[8]
Effective treatment of early Barrett's neoplasia with stepwise circumferential and focal ablation using the HALO system [J].
Gondrie, J. J. ;
Pouw, R. E. ;
Sondermeijer, C. M. T. ;
Peters, F. P. ;
Curvers, W. L. ;
Rosmolen, W. D. ;
Ten Kate, F. ;
Fockens, P. ;
Bergman, J. J. .
ENDOSCOPY, 2008, 40 (05) :370-379
[9]
Stepwise circumferential and focal ablation of Barrett's esophagus with high-grade dysplasia: results of the first prospective series of 11 patients [J].
Gondrie, J. J. ;
Pouw, R. E. ;
Sondermeijer, C. M. T. ;
Peters, F. P. ;
Curvers, W. L. ;
Rosmolen, W. D. ;
Krishnadath, K. K. ;
Ten Kate, F. ;
Fockens, P. ;
Bergman, J. J. .
ENDOSCOPY, 2008, 40 (05) :359-369
[10]
Pathology of Barrett's esophagus [J].
Haggitt, RC .
JOURNAL OF GASTROINTESTINAL SURGERY, 2000, 4 (02) :117-118