Year 2017 / Volume 109 / Number 3
Original
The importance of a second opinion in the diagnosis of Barrett’s esophagus: a “real life” study

185-189

DOI: 10.17235/reed.2016.4505/2016

Vincenzo Villanacci, Marianna Salemme, Italo Stroppa, Valerio Balassone, Gabrio Bassotti,

Abstract
Background: Barrett’s esophagus is a precancerous lesion, and its identification with the early detection of dysplasia is of paramount importance to prevent adenocarcinoma onset. However, there is still debate on the correct pathological identification of Barrett’s esophagus (and of associated dysplasia), and most studies have been conducted in an experimental setting. Aims: To assess previous uncertain diagnoses of Barrett’s (with and without dysplasia) via a second opinion of an expert pathologist in a real life setting. Patients and methods: Histological sections of 32 suspected Barrett’s patients from ten general Pathology units were centralized into one single unit in which an expert pathologist reviewed the slides blindly. Results: Overall, in 78% of cases there was diagnostic discordance; in particular, in 64% of cases the presence of low grade dysplasia was not confirmed. Of interest, 28% of cases with the original diagnosis were reclassified as non-Barrett’s. Conclusions: The pathological diagnosis of Barrett’s esophagus, especially with regard to the presence of dysplasia, is still misinterpreted, particularly in the setting of general Pathology units. Thus, a second opinion from an experienced pathologist may help in the interpretation of the results and in starting appropriate follow-up programs.
Share Button
New comment
Comments
No comments for this article
References
1. Naini BV, Souza RF, Odze RD. Barrett's Esophagus: a comprehensive and contemporary review for pathologists. Am J Surg Pathol 2016, 40:e45-66
2. Shaheen NJ, Richter JE. Barrett’s oesophagus. Lancet 2009, 373:850-861
3. Fiocca R, Mastracci L, Milione M, et al. Microscopic esophagitis and Barrett's esophagus: the histology report. Dig Liver Dis 2011, 43(Suppl 4):S319-330
4. Pera M. Trends in incidence and prevalence of specialized intestinal metaplasia, Barrett’s esophagus, and adenocarcinoma of the gastroesophageal junction. World J Surg 2003, 27:999-1108
5. Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006, 101:1900-1920
6. Cohen J, Safdi MA, Deal SE, et al. Quality indicators for esophagogastroduodenoscopy. Am J Gastroenterol 2006, 101:886-891
7. Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C & M criteria. Gastroenterology 2006, 131:1392-1399
8. Gopal DV, Lieberman DA, Magaret N, et al. Risk factors for dysplasia in patients with Barrett's esophagus (BE): results from a multicenter consortium. Dig Dis Sci 2003, 48:1537-1541
9. Menezes A, Tierney A, Yang YX, et al. Adherence to the 2011 American Gastroenterological Association medical position statement for the diagnosis and management of Barrett's esophagus. Dis Esophagus 2015, 28:538-546
10. Dunn SJ, Neilson LJ, Hassan C, et al. ESGE Survey: worldwide practice patterns amongst gastroenterologists regarding the endoscopic management of Barrett's esophagus. Endosc Int Open 2016, 4:E36-41
11. Naini BV, Chak A, Ali MA, et al. Barrett's oesophagus diagnostic criteria: endoscopy and histology. Best Pract Res Clin Gastroenterol 2015, 29:77-96
12. Spechler SJ, Sharma P, Souza RF, et al. American gastroenterological association medical position statement on the management of Barrett's esophagus. Gastroenterology 2011,140:1084-1091
13. Riddell RH, Odze RD. Definition of Barrett's esophagus: time for a rethink. Is intestinal metaplasia dead? Am J Gastroenterol 2009, 104:2588-2594
14. Villanacci V, Bellone G, Battaglia E, et al. Ski/SnoN expression in the sequence metaplasia-dysplasia-adenocarcinoma of Barrett's esophagus. Hum Pathol 2008, 39:403-409
15. Rossi E, Grisanti S, Villanacci V, et al. HER-2 overexpression/amplification in Barrett's oesophagus predicts early transition from dysplasia to adenocarcinoma: a clinico-pathologic study. J Cell Mol Med 2009, 13:3826-3833
16. Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut 2014, 63:7-42
17. Ogiya K, Kawano T, Ito E, et al. Lower esophageal palisade vessels and the definition of Barrett's esophagus. Dis Esophagus 2008, 21:645-649
18. Skacel M, Petras RE, Gramlich TL, et al. The diagnosis of low grade dysplasia in Barrett's esophagus and its implication for disease progression. Am J Gastroenterol 2000, 95:3383-3387
19. Montgomery E, Bronner MP, Goldblum JR, et al. Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Hum Pathol 2001, 32:368-378
20. Kaye PV, Haider SA, Ilyas M, et al. Barrett's dysplasia and the Vienna classification: reproducibility, prediction of progression and impact of consensus reporting and p53 immunohistochemistry. Histopathology 2009, 54:699-712
21. Coco DP, Goldblum JR, Hornick JL, et al. Interobserver variability in the diagnosis of crypt dysplasia in Barrett esophagus. Am J Surg Pathol 2011, 35:45-54
22. Bennett C, Vakil N, Bergman J, et al. Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology 2012, 143:336-346
23. Villanacci V, Rossi E, Zambelli C, et al. COX-2, CDX2, and CDC2 immunohistochemical assessment for dysplasia-carcinoma progression in Barrett's esophagus. Dig Liver Dis 2007, 39:305-311
24. Cohen J. A coefficient of agreement for nominal scales. Education Psychol Measur 1960, 20:37-46
25. Fleiss JL, Levin B, Paik MC. Statistical methods for rates and proportions, 3rd ed. John Wiley & Sons, Hoboken, 2003
26. Duits LC, Phoa KN, Curvers WL, et al. Barrett's oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel. Gut 2015, 64:700-706
27. Sangle NA, Taylor SL, Emond MJ, et al. Overdiagnosis of high-grade dysplasia in Barrett's esophagus: a multicenter, international study. Mod Pathol 2015, 28:758-765
28. Yantiss RK. Diagnostic challenges in the pathologic evaluation of Barrett esophagus. Arch Pathol Lab Med 2010, 134:1589-1600
29. Odze RD. Barrett esophagus: histology and pathology for the clinician. Nat Rev Gastroenterol Hepatol 2009, 6:478-490
30. Corley DA, Kubo A, DeBoer J, et al. Diagnosing Barrett’s esophagus: reliability of clinical and pathologic diagnoses. Gastrointest Endosc 2009, 69:1004-1010
31. Pech O, Vieth M, Schmitz D, et al. Conclusions from the histological diagnosis of low-grade intraepithelial neoplasia in Barrett's oesophagus. Scand J Gastroenterol 2007, 42:682-688
32. Curvers WL, ten Kate FJ, Krishnadath KK, et al. Low-grade dysplasia in Barrett's esophagus: overdiagnosed and underestimated. Am J Gastroenterol 2010, 105:1523-1530
33. Mastracci L, Piol N, Molinaro L, et al. Interobserver reproducibility in pathologist interpretation of columnar-lined esophagus. Virchows Arch 2016, 468:159-167
34. Villanacci V, Bassotti G, Salemme M, et al. Influence of genetics on tumoral pathologies: the example of the adenocarcinoma arising in Barrett's esophagus. Rev Esp Enferm Dig 2012, 104:592-602
35. Salemme M, Villanacci V, Cengia G, et al. Intestinal metaplasia in Barrett's oesophagus: An essential factor to predict the risk of dysplasia and cancer development. Dig Liver Dis 2016, 48:144-147
36. Rubenstein JH. Surveillance in Barrett's esophagus: utility and current recommendations. Gastroenterol Clin North Am 2015, 44:285-297
37. Singh R, Yeap SP, Cheong KL. Detection and characterization of early malignancy in the esophagus: what is the best management algorithm? Best Pract Res Clin Gastroenterol 2015, 29:533-544
38. Butt J, Kandel G. Barrett esophagus: when to endoscope. Clin Endosc 2014, 47:40-46
39. Sharma P, Hawes RH, Bansal A, et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus: a prospective, international, randomised controlled trial. Gut 2013, 62:15-21
40. Verna C, Feyles E, Lorenzi L, et al. I-SCAN targeted versus random biopsies in Barrett's oesophagus. Dig Liver Dis 2014, 46:131-134
41. Bertani H, Frazzoni M, Dabizzi E, et al. Improved detection of incident dysplasia by probe-based confocal laser endomicroscopy in a Barrett's esophagus surveillance program. Dig Dis Sci 2013, 58:188-193
42. Xiong YQ, Ma SJ, Zhou JH, et al. A meta-analysis of confocal laser endomicroscopy for the detection of neoplasia in patients with Barrett's esophagus. J Gastroenterol Hepatol 2016, 31:1102-1110
Related articles

Letter

Blue rubber bleb nevus syndrome

DOI: 10.17235/reed.2023.9913/2023

Letter

Capsule endoscopy diagnosis of gastrointestinal melanoma

DOI: 10.17235/reed.2023.9803/2023

Letter

Calcifying fibrous tumor and pathological analysis

DOI: 10.17235/reed.2023.9739/2023

Letter

Endoscopic observation of a rare duodenal tumor

DOI: 10.17235/reed.2023.9679/2023

Letter

Endoscopic rescue of a fistulizing biliary plastic stent

DOI: 10.17235/reed.2023.9673/2023

Letter

MALT lymphoma of the colon: an endoscopic challenge

DOI: 10.17235/reed.2023.9595/2023

Letter

Sigmoid volvulus management, only endoscopic devolvulation?

DOI: 10.17235/reed.2023.9488/2023

Letter

Isolated Jejunal Crohn's Disease: a challenging diagnosis

DOI: 10.17235/reed.2022.9423/2022

Letter

New technique for the endoscopic removal of long foreign bodies

DOI: 10.17235/reed.2023.9398/2022

Digestive Diseases Image

Whipple’s disease – A typical endoscopic finding of a rare disease

DOI: 10.17235/reed.2022.9338/2022

Digestive Diseases Image

A rare endoscopic pattern in a patient with gastroesophageal reflux disease

DOI: 10.17235/reed.2022.9124/2022

Digestive Diseases Image

Esophageal tuberculosis

DOI: 10.17235/reed.2022.9108/2022

Digestive Diseases Image

Esophagopleural fistula due to empyema necessitans

DOI: 10.17235/reed.2022.9085/2022

Digestive Diseases Image

Pneumatosis intestinalis: a rare endoscopic feature of colonic ischemia

DOI: 10.17235/reed.2022.8980/2022

Letter

Primary intestinal melanoma?

DOI: 10.17235/reed.2022.8944/2022

Letter

Intestinal amyloidosis: a diagnostic challenge

DOI: 10.17235/reed.2022.8934/2022

Letter

Successful gallstone ileus treatment by endoscopy

DOI: 10.17235/reed.2022.8898/2022

Letter

Digestive tract MALT lymphoma, an unusual location

DOI: 10.17235/reed.2022.8800/2022

Digestive Diseases Image

Esophageal epidermoid metaplasia: an unusual condition

DOI: 10.17235/reed.2022.8708/2022

Digestive Diseases Image

Ileal neuroendocrine tumor as an uncommon cause of obscure gastrointestinal bleeding

DOI: 10.17235/reed.2022.8641/2022

Digestive Diseases Image

A case of duodenal-type follicular lymphoma

DOI: 10.17235/reed.2021.8233/2021

Digestive Diseases Image

Endoscopic resection of a duodenal neuroendocrine tumor

DOI: 10.17235/reed.2021.8232/2021

Digestive Diseases Image

Duodenal-type follicular lymphoma: a silent tumor

DOI: 10.17235/reed.2021.8149/2021

Digestive Diseases Image

Primary or idiopathic intestinal pneumatosis: a rare casual endoscopic finding

DOI: 10.17235/reed.2021.8049/2021

Letter

Bochdalek hernia: use of capsule endoscopy

DOI: 10.17235/reed.2021.7760/2020

Digestive Diseases Image

Endoscopic forceps removal for complicated magnetic beads impaction

DOI: 10.17235/reed.2021.7731/2020

Digestive Diseases Image

Esophageal involvement in a patient with pemphigus vulgaris

DOI: 10.17235/reed.2020.7417/2020

Letter

Basic training in gastrointestinal endoscopy: recording images

DOI: 10.17235/reed.2020.7385/2020

Letter

Development of Barrett’s esophagus after a total gastrectomy

DOI: 10.17235/reed.2020.7041/2020

Review

Advanced therapy by device-assisted enteroscopy

DOI: 10.17235/reed.2020.6971/2020

Letter

Luetic gastritis: an uncommon cause of gastritis

DOI: 10.17235/reed.2020.6870/2020

Letter

Barrett’s esophagus is a controversial condition

DOI: 10.17235/reed.2020.6736/2019

Letter

Gastric ulcer due to mucormycosis in a critical patient

DOI: 10.17235/reed.2020.6636/2019

Letter

Primary gastric choriocarcinoma

DOI: 10.17235/reed.2020.6478/2019

Digestive Diseases Image

Jejunal schwannoma detected by video capsule endoscopy

DOI: 10.17235/reed.2020.6474/2019

Digestive Diseases Image

Capsule endoscopy, a useful tool for the diagnosis of a tapeworm infection

DOI: 10.17235/reed.2019.6346/2019

Editorial

Endoscopy units – Statu quo

DOI: 10.17235/reed.2019.6347/2019

Letter

Endoscopically diagnosed systemic mastocytosis

DOI: 10.17235/reed.2019.6246/2019

Digestive Diseases Image

A rare heterotopic gastric mucosa appearing between the muscularis mucosae and submucosa

DOI: 10.17235/reed.2019.6134/2018

Special Article

Quality indicators in gastroscopy. Gastroscopy procedure

DOI: 10.17235/reed.2019.6023/2018

Letter

Endoscopic management of Boerhaave’s syndrome

DOI: 10.17235/reed.2019.6013/2018

Digestive Diseases Image

Intraductal papillary mucinous neoplasm of the main duct in a patient with pancreas divisum

DOI: 10.17235/reed.2019.5959/2018

Letter

Use of patency capsule in daily practice

DOI: 10.17235/reed.2019.5952/2018

Case Report

Serrated Lesions in patients with Inflammatory Bowel Disease.

DOI: 10.17235/reed.2019.5910/2018

Letter

Symptomatic exfoliative esophagitis induced by dabigatran

DOI: 10.17235/reed.2018.5747/2018

Special Article

The current situation of digestive endoscopy units in the Valencian Community

DOI: 10.17235/reed.2019.5676/2018

Special Article

Endoscopy and sedation: an inseparable binomial for the gastroenterologist

DOI: 10.17235/reed.2018.5585/2018

Digestive Diseases Image

Dysphagia and hematemesis caused by an intramural esophageal dissection

DOI: 10.17235/reed.2018.5471/2018

Letter to the Editor

GETTEMO position statement on bariatric endoscopic techniques as a voluntary medicine

DOI: 10.17235/reed.2017.5144/2017

Digestive Diseases Image

Metastasis of dermatofibrosarcoma diagnosed by capsule endoscopy

DOI: 10.17235/reed.2018.4900/2017

Letter to the Editor

Symptomatic retention of the Agile® patency capsule

DOI: 10.17235/reed.2017.4691/2016

Letter to the Editor

Ball valve syndrome caused by a giant gastric Vanek’s tumor

DOI: 10.17235/reed.2017.4526/2016

Original

Multicenter study on the safety of bariatric endoscopy

DOI: 10.17235/reed.2017.4499/2016

Letter to the Editor

Endoscopic removal of a hashish packet

DOI: 10.17235/reed.2017.4504/2016

Letter to the Editor

Whipple’s disease under the vision of capsule endoscopy

DOI: 10.17235/reed.2016.4362/2016

Letter to the Editor

Asymptomatic bronchial aspiration of capsule endoscope: a significant complication

DOI: 10.17235/reed.2016.4363/2016

Letter to the Editor

Author´s reply: About human taeniasis and Taenia saginata diagnosis by endoscopy

DOI: 10.17235/reed.2016.4339/2016

Letter to the Editor

About human taeniasis and Taenia saginata diagnosis by endoscopy

DOI: 10.17235/reed.2016.4297/2016

Letter to the Editor

Transanal submucosal endoscopic resection (TASER) by TEO system®

DOI: 10.17235/reed.2016.4154/2015

Case Report

Atypical diagnosis diagnosis by endoscopic capsule: Whipple´s disease

DOI: 10.17235/reed.2015.3718/2015

Citation tools
Villanacci V, Salemme M, Stroppa I, Balassone V, Bassotti G. The importance of a second opinion in the diagnosis of Barrett’s esophagus: a “real life” study . 4505/2016


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 5575 visits.
This article has been downloaded 72 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 22/06/2016

Accepted: 21/07/2016

Online First: 27/12/2016

Published: 28/02/2017

Article revision time: 29 days

Article Online First time: 188 days

Article editing time: 251 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology