Trial reportModern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc2015
Overdiagnosis of high-grade dysplasia in Barrett's esophagus: a multicenter, international study.
Trial report in Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed.
- Biomarker Use in Barrett's Esophagus Surveillance.The American journal of gastroenterology · 2026Review
- Current Concepts for Diagnosing Non-Dysplastic and Dysplastic Barrett's Esophagus.Gastrointestinal endoscopy clinics of North America · 2026Review
- A Simple, Interpretable Machine Learning Model Based on Clinical Factors Accurately Predicts Incident Dysplasia or Malignancy in Barrett's Esophagus.Digestive diseases and sciences · 2025Article
- Navigating Endoscopic Surveillance and Management of Barrett's Esophagus in Elderly Patients: Balancing the Risks and Benefits.Current gastroenterology reports · 2025Review
- The Aberrant Expression of Biomarkers and Risk Prediction for Neoplastic Changes in Barrett's Esophagus-Dysplasia.Cancers · 2024Article
- Gastro-Esophageal Junction Precancerosis: Histological Diagnostic Approach and Pathogenetic Insights.Cancers · 2023Review
- Unmet needs in Barret's esophagus diagnosis and treatment: a narrative review.Translational gastroenterology and hepatology · 2023Review
- Utility of ancillary studies in the diagnosis and risk assessment of Barrett's esophagus and dysplasia.Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc · 2022Review
- Barrett's esophagus: Review of natural history and comparative efficacy of endoscopic and surgical therapies.World journal of gastrointestinal oncology · 2022Review
- Overdiagnosis of hepatocellular carcinoma: Prevented by guidelines?Hepatology (Baltimore, Md.) · 2022Review
- Abnormal TP53 Predicts Risk of Progression in Patients With Barrett's Esophagus Regardless of a Diagnosis of Dysplasia.Gastroenterology · 2022Article
- Barrett's esophagus: The pathomorphological and molecular genetic keystones of neoplastic progression.Cancer medicine · 2022Review
- Persistent or recurrent Barrett's neoplasia after an endoscopic therapy session is associated with DNA content abnormality and can be detected by DNA flow cytometric analysis of paraffin-embedded tissue.Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc · 2021Article
- LGR5 in Barrett's Esophagus and its Utility in Predicting Patients at Increased Risk of Advanced Neoplasia.Clinical and translational gastroenterology · 2020Article
- [Pathology of early stage cancer of the gastrointestinal tract : Definition, principles and diagnosis].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2018Review
- Value of histomorphometric tumour thickness and smoothelin for conventional m-classification in early oesophageal adenocarcinoma.World journal of gastrointestinal oncology · 2017Article
- Development of Quality Indicators for Endoscopic Eradication Therapies in Barrett's Esophagus: The TREAT-BE (Treatment With Resection and Endoscopic Ablation Techniques for Barrett's Esophagus) Consortium.The American journal of gastroenterology · 2017Review
- p53 protein accumulation predicts malignant progression in Barrett's metaplasia: a prospective study of 275 patients.Histopathology · 2017Article
- Quality Indicators in Endoscopic Ablation for Barrett's Esophagus.Current treatment options in gastroenterology · 2017Review
- Increasing diagnostic accuracy to grade dysplasia in Barrett's esophagus using an immunohistochemical panel for CDX2, p120ctn, c-Myc and Jagged1.Diagnostic pathology · 2016Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Numerous histological mimics of high-grade dysplasia in Barrett's esophagus predispose to overdiagnosis and potential serious mismanagement, including unnecessary esophagectomy. This study investigates the prevalence and sources of this problem. Biopsies from 485 patients diagnosed with Barrett's high-grade dysplasia were screened for a multi-institutional, international Barrett's endoscopic ablation trial. Screening included review of the original diagnostic slides and an additional protocol endoscopy with an extensive biopsy sampling. Observer variability by the study pathologists was assessed through two blinded diagnostic rounds on 437 biopsies from 26 random study endoscopies. Study diagnostic reassessments revealed significantly lower rates of high-grade dysplasia. Only 248 patients (51%) were confirmed to have high-grade dysplasia. The remaining patients had inflamed gastric cardia without Barrett's (n=18; 7%), Barrett's without dysplasia (n=35; 15%), indefinite change (n=61; 26%), low-grade dysplasia (n=79; 33%), adenocarcinoma (n=43; 18%), and other (n=1; <1%), yielding an alarming total of 194 or 40% of patients who were overdiagnosed with Barrett's high-grade dysplasia. Study pathologists achieved a high-level agreement (90% three-way inter-observer agreement per biopsy, Kappa value 0.77) for high-grade dysplasia. Confounding factors promoting overdiagnosis included Barrett's inflammatory atypia (n=182), atypia limited to the basal metaplastic glands (n=147), imprecise criteria for low grade neoplasia (n=102), tangential sectioning artifact (n=59), and reactive gastric cardiac mucosa (n=38). A total of 194 patients (40%) were overdiagnosed with Barrett's high-grade dysplasia, as affirmed by the extensive screening process and high-level study pathologist agreement. The multiple diagnostic pitfalls uncovered should help raise pathologists' awareness of this problem and improve diagnostic accuracy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.