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Definition of Barrett’s Esophagus Dysplasia: Are We Speaking the Same Language?

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Abstract

The definition of Barrett’s esophagus (BE) is still a matter of debate. The diagnostic criteria adopted around the world for both BE and BE-related pre-cancerous lesions are inconsistent, particularly between Eastern and Western pathologists. From a clinical perspective, these different clinico-biological approaches may affect how the literature is interpreted, with detrimental effects on the clinical management of patients. The present review focuses on the major discrepancies in the field, covering both the non-neoplastic and the pre-cancerous lesions associated with Barrett’s disease.

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Abbreviations

aFH:

Atypical foveolar hyperplasia

BAc:

Barrett’s adenocarcinoma

BE:

Barrett’s esophagus

EGJ:

Esophago-gastric junction

GERD:

Gastroesophageal reflux disease

GI:

Gastrointestinal

GM:

Gastric metaplasia

HG-IEN:

High-grade intraepithelial neoplasia

HIM:

Hyperproliferative intestinal metaplasia

IM:

Intestinal metaplasia

LG-IEN:

Low-grade intraepithelial neoplasia

References

  1. Descartes R (1998) Discourse on method and meditations on first philosophy. Hackett Publishing Company, Indianapolis

    Google Scholar 

  2. Barrett NR (1950) Chronic peptic ulcer of the oesophagus and “oesophagitis”. Br J Surg 38:175–182

    Article  CAS  PubMed  Google Scholar 

  3. Riddell RH, Odze RD (2009) Definition of Barrett’s esophagus: time for a rethink—is intestinal metaplasia dead? Am J Gastroenterol 104(10):2588–2594

    Article  PubMed  Google Scholar 

  4. de Jonge PJ, van Blankenstein M, Grady WM et al (2014) Barrett’s oesophagus: epidemiology, cancer risk and implications for management. Gut 63(1):191–202

    Article  PubMed  Google Scholar 

  5. Takubo K, Arai T, Sawabe M et al (2003) Structures of the normal esophagus and Barrett’s esophagus. Esophagus 1:37–47

    Article  Google Scholar 

  6. Hvid-Jensen F, Pedersen L, Drewes AM et al (2011) Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 365:1375–1383

    Article  CAS  PubMed  Google Scholar 

  7. Rugge M, Capelle LG, Cappellesso R et al (2013) Precancerous lesions in the stomach: from biology to clinical patient management. Best Pract Res Clin Gastroenterol 27(2):205–223

    Article  PubMed  Google Scholar 

  8. Japan Esophageal Society (2009) Japanese classification of esophageal cancer, tenth edition: parts II and III. Esophagus 6:71–94

    Article  Google Scholar 

  9. Fitzgerald RC, di Pietro M, Ragunath K et al (2014) British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut 63(1):7–42

    Article  PubMed  Google Scholar 

  10. Jass JR (2000) Discrepancies between East and West. Cancer 88(5):969–970

    Article  CAS  PubMed  Google Scholar 

  11. Mueller J, Werner M, Stolte M (2004) Barrett’s esophagus: histopathologic definitions and diagnostic criteria. World J Surg 28(2):148–154. doi:10.1007/s00268-003-7050-4

    Article  PubMed  Google Scholar 

  12. Paull A, Trier JS, Dalton MD et al (1976) The histologic spectrum of Barrett’s esophagus. N Engl J Med 295:476–480

    Article  CAS  PubMed  Google Scholar 

  13. Fiocca R, Mastracci L, Milione M et al (2011) Microscopic esophagitis and Barrett’s esophagus: the histology report. Dig Liver Dis 43(Suppl 4):S319–S330

    Article  PubMed  Google Scholar 

  14. Takubo K, Vieth M, Aida J et al (2009) Differences in the definitions used for esophageal and gastric diseases in different countries: endoscopic definition of the esophagogastric junction, the precursor of Barrett’s adenocarcinoma, the definition of Barrett’s esophagus, and histologic criteria for mucosal adenocarcinoma or high-grade dysplasia. Digestion 80(4):248–257

    Article  PubMed  Google Scholar 

  15. Sharma P, Dent J, Armstrong D et al (2006) The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 131(5):1392–1399

    Article  PubMed  Google Scholar 

  16. Spechler SJ, Sharma P, Souza RF et al (2011) American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology 140:e18–e52

    Article  PubMed Central  PubMed  Google Scholar 

  17. Amano Y, Ishimura N, Furuta K et al (2006) Which landmark results in a more consistent diagnosis of Barrett’s esophagus, the gastric folds or the palisade vessels? Gastrointest Endosc 64:206–211

    Article  PubMed  Google Scholar 

  18. Rugge M, Fassan M, Battaglia G et al (2009) Intestinal or gastric? The unsolved dilemma of Barrett’s metaplasia. Hum Pathol 40(8):1206–1207

    Article  PubMed  Google Scholar 

  19. Smith RR, Hamilton SR, Boitnott JK et al (1984) The spectrum of carcinoma arising in Barrett’s esophagus. A clinicopathologic study of 26 patients. Am J Surg Pathol 8:563–573

    Article  CAS  PubMed  Google Scholar 

  20. Bhat S, Coleman HG, Yousef F et al (2011) Risk of malignant progression in Barrett’s esophagus patients: results from a large population-based study. J Natl Cancer Inst 103:1049–1057

    Article  PubMed Central  PubMed  Google Scholar 

  21. Spechler SJ, Sharma P, Souza RF et al (2011) American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology 140(3):1084–1091

    Article  PubMed  Google Scholar 

  22. Vakil N, van Zanten SV, Kahrilas P et al (2006) The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101(8):1900–1920

    Article  PubMed  Google Scholar 

  23. Jankowski JA, Harrison RF, Perry I et al (2000) Barrett’s metaplasia. Lancet 356(9247):2079–2085

    Article  CAS  PubMed  Google Scholar 

  24. Kelty CJ, Gough MD, Van Wyk Q et al (2007) Barrett’s oesophagus: intestinal metaplasia is not essential for cancer risk. Scand J Gastroenterol 42(11):1271–1274

    Article  PubMed  Google Scholar 

  25. Takubo K, Aida J, Naomoto Y et al (2009) Cardiac rather than intestinal-type background in endoscopic resection specimens of minute Barrett adenocarcinoma. Hum Pathol 40:65–74

    Article  PubMed  Google Scholar 

  26. Japan Esophageal Society (2009) Japanese classification of esophageal cancer, tenth edition: part I. Esophagus 6:1–25

    Article  Google Scholar 

  27. Hahn HP, Blount PL, Ayub K et al (2009) Intestinal differentiation in metaplastic, nongoblet columnar epithelium in the esophagus. Am J Surg Pathol 33(7):1006–1015

    Article  PubMed Central  PubMed  Google Scholar 

  28. Fassan M, Volinia S, Palatini J et al (2013) MicroRNA expression profiling in the histological subtypes of Barrett’s metaplasia. Clin Transl Gastroenterol 4:e34

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Oryu M, Mori H, Kobara H et al (2013) Differences in the characteristics of Barrett’s esophagus and Barrett’s adenocarcinoma between the United States and Japan. ISRN Gastroenterol 2013:840690

    Article  PubMed Central  PubMed  Google Scholar 

  30. Odze RD, Riddell RH, Bosman FT et al (2010) Premalignant lesions of the digestive system. In: Bosman FT, Carneiro F, Hruban RH et al (eds) WHO classification of tumours of the digestive system. IARC, Lyon, pp 10–12

    Google Scholar 

  31. Schlemper RJ, Itabashi M, Kato Y et al (1997) Differences in diagnostic criteria for gastric carcinoma between Japanese and Western pathologists. Lancet 349(9067):1725–1729

    Article  CAS  PubMed  Google Scholar 

  32. Takubo K, Arai T, Ishiguro S (2002) Patient presentation and pathologic diagnosis of superficial carcinoma of the esophagus: high-grade dysplasia and mucosal carcinoma from the Japanese standpoint. In: Imamura M (ed) Superficial esophageal neoplasm: pathology, diagnosis, and therapy. Springer, Tokyo, pp 141–147

    Chapter  Google Scholar 

  33. Rugge M, Correa P, Dixon MF et al (2000) Gastric dysplasia: the Padova international classification. Am J Surg Pathol 24(2):167–176

    Article  CAS  PubMed  Google Scholar 

  34. Fassan M, Pizzi M, Farinati F et al (2012) Lesions indefinite for intraepithelial neoplasia and OLGA staging for gastric atrophy. Am J Clin Pathol 137:727–732

    Article  PubMed  Google Scholar 

  35. Japanese Gastric Cancer Association (2011) Japanese classification of esophageal cancer, tenth edition: part I. Gastric Cancer 14:101–112

    Article  Google Scholar 

  36. Schlemper RJ, Riddell RH, Kato Y et al (2000) The Vienna classification of gastrointestinal epithelial neoplasia. Gut 47:251–255

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  37. Dixon MF (2002) Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 51(1):130–131

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  38. Dobbins W (1966) The intestinal mucosal lymphatic in man. A light and electron microscopic study. Gastroenterol 51(6):994–1003

    Google Scholar 

  39. Akashi Y, Noguchi T, Nagai K et al (2011) Cytoarchitecture of the lamina muscularis mucosae and distribution of the lymphatic vessels in the human stomach. Med Mol Morphol 44(1):39–45

    Article  PubMed  Google Scholar 

  40. Flejou JF, Odze RD, Montgomery E et al (2010) Adenocarcinoma of the oesophagus. In: Bosman FT, Carneiro F, Hruban RH et al (eds) WHO classification of tumours of the digestive system. IARC, Lyon, pp 27–28

    Google Scholar 

  41. Fassan M, Baffa R, Kiss A et al (2013) MicroRNA dysregulation in esophageal neoplasia: the biological rationale for novel therapeutic options. Curr Pharm Des 19(7):1236–1241

  42. Pizzi M, Fassan M, Realdon S et al (2012) Anterior gradient 2 profiling in Barrett columnar epithelia and adenocarcinoma. Hum Pathol 43(11):1839–1844

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Acknowledgments

The authors wish to acknowledge the support of the Italian Association for Cancer Research (AIRC Regional grant 2008 no. 6421).

Conflict of interest

None to declare.

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Authors and Affiliations

  1. Department of Medicine-DIMED, Surgical Pathology and Cytopathology Unit, University of Padova, via A. Gabelli, 61, 35121, Padova, Italy

    Massimo Rugge & Marco Pizzi

  2. Department of Surgery, Istituto Oncologico Veneto – IOV, Padova, Italy

    Massimo Rugge & Carlo Castoro

Authors
  1. Massimo Rugge
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  2. Marco Pizzi
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  3. Carlo Castoro
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Corresponding author

Correspondence to Massimo Rugge.

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Rugge, M., Pizzi, M. & Castoro, C. Definition of Barrett’s Esophagus Dysplasia: Are We Speaking the Same Language?. World J Surg 39, 559–565 (2015). https://doi.org/10.1007/s00268-014-2692-y

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  • DOI: https://doi.org/10.1007/s00268-014-2692-y

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