Tissue Systems Pathology Test Objectively Risk Stratifies Barrett's Esophagus Patients With Low-Grade Dysplasia.

Autor:	Frei NF; 1Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands; 2Cernostics, Pittsburgh, Pennsylvania, USA; 3Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; 4Department of Pathology, University Medical Center, Utrecht, the Netherlands; 5Department of Pathology, Pathology DNA-BV, St. Antonius Hospital, Nieuwegein, the Netherlands; 6Department of Pathology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands., Khoshiwal AM, Konte K, Bossart EA, Stebbins K, Zhang Y, Pouw RE, Ten Kate FJW, Seldenrijk KA, Meijer SL, Critchley-Thorne RJ, Bergman JJGHM
Jazyk:	angličtina
Zdroj:	The American journal of gastroenterology [Am J Gastroenterol] 2021 Apr; Vol. 116 (4), pp. 675-682.
DOI:	10.14309/ajg.0000000000001037
Abstrakt:	Introduction: Low-grade dysplasia (LGD) is the best predictor of neoplastic progression in Barrett's esophagus (BE). Most LGD cases are downstaged to nondysplastic (ND) BE on expert pathologist review, which is prone to interobserver variation and not widely available. Recent studies indicate that a risk prediction assay (TissueCypher) risk stratifies patients with NDBE for neoplastic progression. We aimed to investigate whether this risk prediction assay predicts neoplastic progression in BE patients with LGD. Methods: A blinded, retrospective cohort study was derived from the screening cohort of a randomized controlled trial of SURveillance vs RadioFrequency ablation for BE patients with LGD. Hematoxylin and eosin and p53 immunohistochemistry slides from the first endoscopy with LGD were independently reviewed by 3 expert pathologists and tested by the risk prediction assay. Revision diagnoses of NDBE were considered low risk, although indefinite for dysplasia, and LGD were considered high risk for progression. Results: A total of 155 BE patients (123 men), mean age 61 ± 10 years, were analyzed. Thirty-four patients (22%) progressed to high-grade dysplasia/esophageal adenocarcinoma (median time 2.4 years) and 121 did not progress (median high-grade dysplasia/esophageal adenocarcinoma-free surveillance 7.9 years). The risk prediction assay sensitivity was 68% vs 76% for the 3 pathologists, and specificity was 79% vs 64%-77.0% for the pathologists. The assay detected 50%-56% of progressors that were downstaged to NDBE by the pathologists. Discussion: The risk prediction assay provided significant risk stratification in BE patients with LGD and identified progressors that the experts downstaged to NDBE. This objective assay provides an effective solution to the lack of standardization of expert pathology review of LGD.
Databáze:	MEDLINE
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