Pathologists set new criteria for cancer precursor

Pathologists tracking the progression of disease from acid reflux to esophageal inflammation to Barrett’s esophagus, a precursor of cancer, can’t always agree on how to evaluate biopsies. Now, a national group of gastrointestinal pathologists founded by a Yale professor has developed new criteria for grading premalignant changes in cells, also referred to as dysplasia.

Criteria for grading dysplasia were established in 1988, but still led to inconsistent results among pathologists. “That grading decision,” said Marie E. Robert, M.D., associate professor of pathology, “is made by looking through a microscope at a slide of a biopsy. It is very subjective.”

Using their new criteria, Robert and 11 other gastrointestinal pathologists found that they agreed more often on categorizing dysplasia. Among the revisions they suggested was more attention to the location of atypical cells. Atypical epithelial cells on the surface of the mucosa are more predictive of future cancer than cells in the deep mucosa. The new criteria also sought to clarify the difference between low-grade dysplasia, which requires routine follow-up, and high-grade dysplasia, which usually prompts surgical resection, Robert said.

A follow-up study of patients found a correlation between diagnoses with the new criteria and cancer risk. “When we modified and discussed the criteria, the risk of developing cancer went up in a linear fashion, after earlier biopsy diagnoses of negative, low-grade and high-grade dsyplasia,” Robert said. “That would argue that our new criteria are valid and can guide clinicians and patients on how they ought to be followed once these diagnoses are made.”

The Gastrointestinal Pathology Study Group, which included pathologists from Johns Hopkins University, the University of Michigan, Vanderbilt University and others, published their findings in April in Human Pathology.