Risk of progression in Barrett’s esophagus based on diagnoses of general and gastrointestinal pathologists. A retrospective case-control study from Northern and Central Finland

Figures & data

Figure 1. Case-control study groups formation after re-evaluation.

Figure 2. Demonstrating original HE microscopic slides in which primary diagnosis was changed from non-dysplastic metaplasia to low-grade dysplasia (a) after expert GI pathologist re-evaluation. (b) original LGD was downgraded to BE, (c) original LGD did not change and (d) original LGD diagnosis was upgraded to HGD. All images are taken with 20x magnification and 100 µm scalebar is found in image D.

Table 1. Characteristics of patients grouped into different progression patterns according to re-assessed diagnoses.

Variable	Group 1 Progressive LGD (patients, n = 24)	Group 2 Non-progressive LGD (patients, n = 45)	Group 3 Progressive BE (patients, n = 22)	Group 4 Non-progressive BE (patients, n = 56)
Follow-up time, years, median (IQR)	9.7 (5.3–14.5)	8.8 (5.8–11.3)	14.2 (8.8–17.3)	14.9 (10.9–18.2)
Number of endoscopies, median (IQR)	7.0 (5.0–12.9)	5.0 (3.0–8.0)	4.0 (2.8–5.3)	3.0 (2.0–5.0)
Number of re-evaluated biopsy samples, median (IQR)	3.5 (3.0–4.8)	2.0 (1.0–2.0)	2.5 (2.0–3.0)	1.0 (1.0–1.0)
Mean age (SD) at end of follow-up	72.5 (9.5)	73.1 (10.9)	70.3 (9.6)	72.4 (8.2)
Male, n (%)	22 (92%)	36 (82%)	13 (59%)	42 (75%)
Reflux symptoms, n (%)	17 (71%)	34 (77%)	20 (91%)	37 (66%)
Prior PPI usage	19 (75%)	36 (78%)	28 (82%)	46 (80%)
Barrett’s length, n (%)
Not available	6 (25%)	17 (39%)	12 (54%)	29 (51%)
<3 cm	4 (17%)	9 (21%)	1 (5%)	13 (23%)
3–10 cm	5 (21%)	13 (29%)	7 (32%)	10 (18%)
≥ 10 cm	9 (37%)	5 (11%)	2 (9%)	4 (7%)

LGD, low-grade dysplasia, BE, non-dysplastic Barrett’s esophagus.

Table 2. Comparison of original and expert GI pathologist diagnoses for each sample. Groups were stratified into progressors (progression to HGD or LGD) and non-progressors accordingly based on expert GI pathologist diagnoses.

Original diagnosis and experts’ diagnosis	Progressor (n)	Experts’ consensus needed (n)	Non-progressor (n)	Experts’ consensus needed (n)
EAC to HGD	2	0
EAC, no change	22	4
EAC, total	24	4
HGD to EAC	3	0	0	0
HGD to LGD	4	1	0	0
HGD to ID	–	0	2	1
HGD, no change	18	6	0	0
HGD, total	25	7	2	1
LGD to HGD	5	2	0	0
LGD to ID	4	2	21	12
LGD to BE	7	0	9	2
LGD, no change	19	8	13	7
LGD, total	35	12	43	21
BE to EAC	1	0	0	0
BE to HGD	1	1	0	0
BE to LGD	5	3	5	3
BE to ID	10	1	12	8
BE, no change	34	5	68	3
BE, total	51	10	75	14

37 re-evaluated samples were excluded from the table. Of these, 25 were excluded due to upstaging of initial BE or LGD to HGD or EAC resulting in loss of the required six-month follow-up. Twelve samples were non-diagnostic.