Barrett Esophagus : Dysplasia Assessment
Dysplasia Assessment in Barrett Esophagus (BE): Pitfalls
- Separation of low-grade dysplasia (LGD) from reactive changes seen in reflux esophagitis can be difficult.
- The interobserver agreement for the diagnosis of LGD is less than 50%.
- The interobserver agreement is about 85% for the diagnosis of high-grade dysplasia (HGD).
- Dysplasia causes only subtle or no endoscopic abnormalities. Recent advances in endoscopy such as narrow band imaging have aided in identification of dysplastic foci during real-time endoscopy.
- Dysplasia is often patchy in extent and severity, causing significant sampling errors with the 4-quadrant biopsy approach used by the endoscopists. In older studies of patients who underwent esophagectomy due to a diagnosis of HGD on biopsies, about 13% of cases showed invasive adenocarcinoma that was missed on biopsies.