Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
Endoscopy. 2015 May;47(5):409-14. doi: 10.1055/s-0034-1391091. Epub 2014 Dec 18.
A histological diagnosis of "indefinite for dysplasia" (IND) in Barrett's esophagus is used when a diagnosis of genuine dysplasia is equivocal. The aim of the present study was to assess the risk of progression to high grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) after a diagnosis of IND in a nationwide cohort of patients with Barrett's esophagus.
Patients with a first diagnosis of IND in Barrett's esophagus between 2002 and 2011 were selected from a nationwide registry of histopathology diagnoses in The Netherlands. Patients were followed up until treatment for HGD, detection of EAC, or date of last endoscopy contact with biopsy sampling.
In total, 1258 patients met the inclusion criteria, of whom 842 (66.9 %) underwent endoscopic follow-up. Patients were followed for a total of 2585 person-years (mean ± SD 3.01 ± 2.6). Median duration until first follow-up endoscopy was 1.2 years (interquartile range 0.3 - 1.8 years). The progression rate from IND to the combined end point of HGD or EAC was 2.0 (95 % confidence interval [CI] 1.5 - 2.6) per 100 person-years and progression to EAC was 1.2 (95 %CI 0.8 - 1.6). After excluding cases with HGD or EAC within 1 year after IND diagnosis (n = 16), the progression rates were 1.4 (95 %CI 1.0 - 1.9) and 0.8 (95 %CI 0.5 - 1.2) per 100 person-years for HGD or EAC and EAC, respectively.
In this large, population-based, cohort of patients with Barrett's esophagus, the incidence rate of HGD or EAC following a diagnosis of IND was 1.4 per 100 person-years. The results demonstrate the need for additional studies to select the subgroup of IND patients with an increased risk of neoplastic progression.
当巴雷特食管的真性异型增生诊断存在争议时，采用“不确定异型增生（IND）”的组织学诊断。本研究的目的是评估在荷兰全国范围内的巴雷特食管患者队列中，诊断为 IND 后进展为高级别异型增生（HGD）或食管腺癌（EAC）的风险。
从荷兰全国组织病理学诊断登记处选择 2002 年至 2011 年间首次诊断为 IND 的巴雷特食管患者。患者随访至 HGD 治疗、EAC 检出或最后一次内镜检查活检采样的日期。
共有 1258 名患者符合纳入标准，其中 842 名（66.9%）接受了内镜随访。患者共随访 2585 人年（平均±标准差 3.01±2.6）。首次随访内镜检查的中位时间为 1.2 年（四分位间距 0.3-1.8 年）。从 IND 到 HGD 或 EAC 联合终点的进展率为 2.0（95%置信区间 1.5-2.6）/100 人年，进展为 EAC 的比例为 1.2（95%置信区间 0.8-1.6）。排除 IND 诊断后 1 年内有 HGD 或 EAC 的病例（n=16）后，HGD 或 EAC 和 EAC 的进展率分别为 1.4（95%置信区间 1.0-1.9）和 0.8（95%置信区间 0.5-1.2）/100 人年。
在这项大型、基于人群的巴雷特食管患者队列研究中，IND 诊断后 HGD 或 EAC 的发生率为 1.4/100 人年。结果表明需要进一步研究来选择异型增生进展风险增加的 IND 患者亚组。
