Progression from low-grade dysplasia to malignancy in patients with Barrett's esophagus diagnosed by two or more pathologists
| Autor: | Prashanth Vennelaganti, Sowmya Dharmapuri, Jaymon Patel, Harsha Moole, Achuta Uppu, Zohair Ahmed, Naveen Bondalapati, Srinivas R. Puli, Raghuveer R. Boddireddy, Abhiram Duvvuri, Vishnu Moole, Pratyusha Yedama, Sreekar Vennelaganti |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Esophageal Neoplasms education Esophageal adenocarcinoma Adenocarcinoma Malignancy digestive system Gastroenterology 03 medical and health sciences Barrett Esophagus 0302 clinical medicine Internal medicine otorhinolaryngologic diseases Medicine Barrett’s esophagus Humans In patient Esophagus Low grade dysplasia neoplasms Aged Observer Variation Hyperplasia High grade dysplasia business.industry Annual incidence of progression General Medicine Middle Aged medicine.disease digestive system diseases Pathologists surgical procedures operative medicine.anatomical_structure Dysplasia 030220 oncology & carcinogenesis Barrett's esophagus Systematic review Disease Progression 030211 gastroenterology & hepatology Female business Precancerous Conditions Meta-Analysis |
| Zdroj: | World Journal of Gastroenterology |
| ISSN: | 2219-2840 1007-9327 |
| Popis: | AIM To evaluate annual incidence of low grade dysplasia (LGD) progression to high grade dysplasia (HGD) and/or esophageal adenocarcinoma (EAC) when diagnosis was made by two or more expert pathologists. METHODS Studies evaluating the progression of LGD to HGD or EAC were included. The diagnosis of LGD must be made by consensus of two or more expert gastrointestinal pathologists. Articles were searched in Medline, Pubmed, and Embase. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic. RESULTS Initial search identified 721 reference articles, of which 53 were selected and reviewed. Twelve studies (n = 971) that met the inclusion criteria were included in this analysis. Among the total original LGD diagnoses in the included studies, only 37.49% reached the consensus LGD diagnosis after review by two or more expert pathologists. Total follow up period was 1532 patient-years. In the pooled consensus LGD patients, the annual incidence rate (AIR) of progression to HGD and or EAC was 10.35% (95%CI: 7.56-13.13) and progression to EAC was 5.18% (95%CI: 3.43-6.92). Among the patients down staged from original LGD diagnosis to No-dysplasia Barrett’s esophagus, the AIR of progression to HGD and EAC was 0.65% (95%CI: 0.49-0.80). Among the patients down staged to Indefinite for dysplasia, the AIR of progression to HGD and EAC was 1.42% (95%CI: 1.19-1.65). In patients with consensus HGD diagnosis, the AIR of progression to EAC was 28.63% (95%CI: 13.98-43.27). CONCLUSION When LGD is diagnosed by consensus agreement of two or more expert pathologists, its progression towards malignancy seems to be at least three times the current estimates, however it could be up to 20 times the current estimates. Biopsies of all Barrett’s esophagus patients with LGD should be reviewed by two expert gastroenterology pathologists. Follow-up strict surveillance programs should be in place for these patients. |
| Databáze: | OpenAIRE |
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