Grading Dysplasia in Barrett's Esophagus
Images For Pathologists: Based on a Large National
Study Centered at Johns Hopkins

Among the 138 patients with clinical follow-up, there were 100 men (72%) and 38 women ranging in age from 9-85 (mean and median 61 and 63 years, respectively). Race was known in 85 patients; 83 were white, 1 was African-American, and 1 was Hispanic.

Based on submitting diagnoses, the average age of patients without dysplasia was 57 years. The age for patients indefinite for dysplasia was 61, for low-grade dysplasia was 60, for high-grade dysplasia was 66, and for intramucosal and frankly invasive adenocarcinoma was 59and 65, respectively. Based on consensus diagnoses, the average age for patients without dysplasia was 57. Ages for indefinite for dysplasia, low-grade dysplasia, high-grade dysplasia, intramucosal adenocarcinoma, and frankly invasive adenocarcinoma were, respectively, 49, 65, 65, 60.5, and 62, respectively.

Progression to Adenocarcinoma

Using the submitting diagnoses from the 10 pathologists who provided slides, no invasive carcinomas were detected in 44 cases submitted as BE without dysplasia in a mean follow-up period of 35 months (range 1-78 months). Three progressed to LG at 11, 12, and 46 months, respectively. High-grade dysplasia was detected in a single patient at 72 months. On resection, no invasive carcinoma was identified. Adenocarcinomas were detected in 4/22 (18%) cases submitted as indefinite for dysplasia at a mean of 68 months. Low-grade dysplsasia was diagnosed in 4 of the patients at a mean of 22 months and no high-grade dysplasia was documented. Carcinomas were detected in 4/26 (15%) cases submitted as low-grade dysplasia at a mean of 26 months and 4 were diagnosed with high-grade dysplasia in 2-7 months. Carcinomas were detected in 20/33 (61%) cases submitted as high-grade dysplasia at a mean of 10 months and in all 13 (100%) cases submitted as intramucosal or frankly invasive carcinoma at a mean of 4 months. Selected cases are depicted.

Table: Barrett's Esophagus with Dysplasia: Correlation with Subsequent Detection of Carcinoma

Overall Survival Versus Grade on Initial Biopsy

At time of last follow-up, none of the 44 patients without dysplasia on initial biopsy was dead of esophageal adenocarcinoma at a mean of 42 months, none of 22 patients indefinite for dysplasia was dead of disease at a mean of 48 months and none of 26 low-grade dysplasia patients was dead of disease at a mean of 31 months. Of patients with an initial diagnosis of high-grade dysplasia, 4/33 (12%) were dead of disease at a mean of 31 months. Patients with an initial diagnosis of intramucosal or frankly invasive adenocarcinoma succumbed to disease (5/13, 38%) in a mean follow-up time of 11 months.