Important practicalities relevant to interpretation of reports on biopsies from BE patients are Selleck Kinase Inhibitor Library commonly poorly understood in routine clinical practice. The quality of surveillance endoscopy and decision-making on the need for intervention is frequently impaired by this poor understanding (Fig. 2). A terminological soup unfortunately adds to the interpretative challenge. This article uses the relatively simple terminology of low and high-grade dysplasia and EA for describing biopsy findings, an approach also used in the 1990 review.1 Other categories of dysplasia that have been and still may be used are “indefinite” and “moderate”, but

these are not usually considered useful by pathologists

working in centers with a special interest in BE.46,47 More recently, “low” and “high grade intraepithelial neoplasm” (LGIN and HGIN) have been introduced in the belief that they are technically better terms that are more Everolimus manufacturer consistent with terminology used for other mucosae than “high” and “low grade dysplasia”, respectively. LGIN and HGIN are clumsy terms (like the growing use of “at this time”, instead of “now”), but more importantly, they are confusing for at least gastroenterologists. Probably, as a consequence, these terms are used by only a few, most being pathologists. Use of the abbreviations LGIN and HGIN is worse, click here since they add to the already daunting code that burdens the understanding of BE-related matters. The diagnosis of low-grade dysplasia is unfortunately usually very inaccurate when this is made by pathologists who are not highly expert in BE.47 In one US study, 65% of 20 general pathologists misdiagnosed a case of low-grade dysplasia; 25% classified it as normal and the other 40% as either moderate or high-grade dysplasia, in equal proportions.48 A more recent US study found that general pathologists had only poor to fair interobserver agreement on the diagnosis

of low-grade dysplasia (Kappa value 0.32).49 In a study from the Netherlands, 85% of low-grade dysplasia cases diagnosed by general pathologists were downgraded to “not dysplasia” on review by pathologists highly expert in BE.50 This experience, consistent with that of Vieth in Germany,47 highlights the important role that centers expert in BE are playing in refining the diagnosis of low-grade dysplasia. So, given these diagnostic problems, should the clinician ignore low-grade dysplasia? No—because as explained below, this finding, when confirmed by an expert BE pathologist, should change management, because it indicates a substantially higher risk for EA when compared to those whose BE is diagnosed as free of dysplasia.