severity of gastrointestinal disease
A national group of gastrointestinal pathologists have Iset new criteria for determining when effects of acid reflux disease are likely to develop into cancer of the esophagus, says Marie Robert, associate professor of pathology at the School of Medicine, who founded the group and participated in the study.
The new criteria are published in a recent issue of the journal Human Pathology, along with a second article that tracked the patients who were diagnosed to see if the pathologists were correct in their assessments.
"A small but significant percentage of people who have chronic gastroesophageal reflux disease will develop inflammation in the lining of the esophagus, and that over time leads to changes referred to as 'Barrett's esophagus,'" says Robert. "People with Barrett's esophagus are predisposed to develop cancer at that site."
Patients with Barrett's esophagus are monitored regularly with biopsies for telltale cellular changes. The pathologists examining biopsies from these at-risk patients are on the lookout for pre-malignant changes in cells. "If these changes are caught early, they can take out the affected portion of the esophagus before it becomes cancerous. Once cancer develops, it's hard to treat and control," Robert says. "However, those of us in the field have long recognized that pathologists have a hard time agreeing with each other on how to grade the pre-malignant changes in these biopsies."
Pathologists from 13 institutions joined together to develop better criteria for determining worrisome changes in patients with Barrett's esophagus. To test these criteria, the pathologists independently examined biopsy slides submitted by their colleagues showing cellular changes, or dysplasia, at five stages; they found that their diagnoses concurred more often in several important categories using the new criteria.
A follow-up of patients whose biopsies were examined in the study showed that those characterized as having no dysplasia showed no evidence of cancer 48 months later; those determined to have indefinite or low-grade dysplasia had an 18% incidence of developing cancer within a 65-month period; and 60% of those diagnosed with high-grade dysplasia developed cancer within seven months.
"This finding gave us more faith that the criteria we are using and the improvements to existing criteria are relevant and should result in better predictability of cellular changes," Robert says.
The institutions taking place in the study were Yale, Johns Hopkins and Vanderbilt universities; the Cleveland Clinic Foundation; MCP Hahnemann University in Philadelphia; Massachusetts General Hospital; Harvard Medical School; Medical University of South Carolina; and the universities of Washington, Michigan, Alabama, Chicago and Arkansas. The lead author of the article is Elizabeth Montgomery from Johns Hopkins University.
-- By Jacqueline Weaver
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