Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9 , Amsterdam 1105 AZ , The Netherlands.
Am J Gastroenterol. 2010 Jul;105(7):1523-30. doi: 10.1038/ajg.2010.171. Epub 2010 May 11.
Published data on the natural history of low-grade dysplasia (LGD) in Barrett's esophagus (BE) are inconsistent and difficult to interpret. We investigated the natural history of LGD in a large community-based cohort of BE patients after reviewing the original histological diagnosis by an expert panel of pathologists.
Histopathology reports of all patients diagnosed with LGD between 2000 and 2006 in six non-university hospitals were reviewed by two expert pathologists. This panel diagnosis was subsequently compared with the histological outcome during prospective endoscopic follow-up.
A diagnosis of LGD was made in 147 patients. After pathology review, 85% of the patients were downstaged to non-dysplastic BE (NDBE) or to indefinite for dysplasia. In only 15% of the patients was the initial diagnosis LGD. Endoscopic follow-up was carried out in 83.6% of patients, with a mean follow-up of 51.1 months. For patients with a consensus diagnosis of LGD, the cumulative risk of progressing to high-grade dysplasia or carcinoma (HGD or Ca) was 85.0% in 109.1 months compared with 4.6% in 107.4 months for patients downstaged to NDBE (P<0.0001). The incidence rate of HGD or Ca was 13.4% per patient per year for patients in whom the diagnosis of LGD was confirmed. For patients downstaged to NDBE, the corresponding incidence rate was 0.49%.
LGD in BE is an overdiagnosed and yet underestimated entity in general practice. Patients diagnosed with LGD should undergo an expert pathology review to purify this group. In case the diagnosis of LGD is confirmed, patients should undergo strict endoscopic follow-up or should be considered for endoscopic ablation therapy.
巴雷特食管（BE）低级别上皮内瘤变（LGD）的自然病史相关数据存在差异且难以解读。本研究通过对一组专家病理学家对原始组织学诊断进行回顾，对大型社区 BE 患者队列中的 LGD 自然病史进行了研究。
对 2000 年至 2006 年期间六家非大学医院诊断为 LGD 的所有患者的组织病理学报告进行回顾，由两位专家病理学家进行审查。该小组的诊断随后与前瞻性内镜随访期间的组织学结果进行比较。
147 例患者被诊断为 LGD。在病理学复查后，85%的患者降期为非异型增生性 BE（NDBE）或异型增生不确定。仅 15%的患者最初诊断为 LGD。83.6%的患者接受了内镜随访，平均随访时间为 51.1 个月。对于共识诊断为 LGD 的患者，在 109.1 个月时进展为高级别异型增生或癌（HGD 或 Ca）的累积风险为 85.0%，而降级为 NDBE 的患者为 107.4 个月时为 4.6%（P<0.0001）。对于诊断为 LGD 的患者，每年每例患者的 HGD 或 Ca 发生率为 13.4%。对于降级为 NDBE 的患者，相应的发生率为 0.49%。
BE 中的 LGD 在一般实践中是一种被过度诊断且被低估的病变。诊断为 LGD 的患者应进行专家病理学审查以纯化该组患者。如果确认诊断为 LGD，则患者应进行严格的内镜随访或考虑内镜消融治疗。
