Endoscopy 2020; 52(S 01): S97
DOI: 10.1055/s-0040-1704296
ESGE Days 2020 oral presentations
Friday, April 24, 2020 11:00-13:00 Endoscopist: RIP! - New diagnostics Wicklow Meeting Room 1 in upper GI endoscopy
© Georg Thieme Verlag KG Stuttgart · New York

LOW-GRADE DYSPLASIA IN BARRETT’S ESOPHAGUS IS DOWNGRADED IN HALF OF THE CASES AFTER SYSTEMATIC EXPERT PATHOLOGY REVIEW BEFORE PATIENT REFERRAL FOR ENDOSCOPIC TREATMENT

P Leclercq
1   KU Leuven, Gastroenterology, Leuven, Belgium
,
G De Hertogh
2   KU Leuven, Pathology, Leuven, Belgium
,
R Bisschops
1   KU Leuven, Gastroenterology, Leuven, Belgium
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

Also available at
 
 

    Aims The aim of this study was to document the discrepancy between expert and community pathologists in grading Barrett´s esophagus (BE) dysplasia before patient referral for endoscopic treatment.

    Methods Between January 2017 and August 2019, sets of biopsy specimen from 129 dysplastic BE patients were referred from community centers to our tertiary referral center for expert pathology review as a prerequisite for dysplastic BE endoscopic management. These slides and blocks were reassessed by two gastro-intestinal (GI) expert pathologists. Diagnosis were stratified according Vienna Classification supported by p53 immunostaining. In this study, we retrospectively documented the discrepancy between expert and community pathologists in grading dysplasia in this selected BE population.

    Results Low-grade dysplasia (LGD) was confirmed by expert pathologist in 33/68 patients (49%), 20 patients (29%) were downgraded to non-dysplastic BE (NDBE), 5 patients (7%) to indefinite for dysplasia (IFD) and 10 patients (15%) were upgraded to high-grade dysplasia (HGD), no cancer was missed. HGD was confirmed by expert pathologist in 52/61 patients (85%), downgraded to NDBE in 1 patient (2%) or to LGD in 4 patients (7%) and upgraded to adenocarcinoma (EAC) in 4 patients (7%).

    Conclusions Discrepancy in BE dysplasia grading between community and tertiary referral centers is still high, especially for LGD. Community diagnosis of LGD is down-staged to NDBE in 49% of the cases after expert GI pathologist review. Therefore, skipping the expert pathology review step in LGD BE patients could lead to overtreat almost half of the patients.


    #