The importance of a second opinion in the diagnosis of Barrett’s esophagus: a “real life” study
2016
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 followup
programs.
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