A Histologically Defined Subset of High-Grade Dysplasia in Barrett Mucosa Is Predictive of Associated Carcinoma

To ascertain the prevalence of carcinoma in esophagi resected for high-grade dysplasia (HGD) using current criteria and to evaluate histologic,features that may predict concurrent carcinoma, we studied specimens from 12 7 esophagectomies performed for HGD, or HGD "suspicious" for carcinoma (HGD/S) it? Barrett mucosa. Corresponding biopsy specimens in 69 cases were reviewed and reclassified. Based on original diagnoses, carcinoma was present in 15 (17%) of 89 HGD and 28 (74%) of 38 HGD/S cases. By reclassification, only 1 (5%) of 21 cases with HGD had carcinoma in the resection specimen. of 25 cases reclassified as HGD/S, 18 (72%) had carcinoma it? the resection specimen, as did 17 (74%) of 23 reclassified as adenocarcinoma. With I additional select histologic feature, the risk of carcinoma was 39%; with 2 or more features, the risk increased to 83% to 88%. Based on current criteria, no more than 5% of esophagectomies performed for a biopsy diagnosis of Barrett HGD harbor carcinoma. When HGD/S is diagnosed based on certain additional features, carcinoma is found in nearly 40% of cases with I feature and more than 80% with 2 or more features. Our findings highlight the evolution of diagnostic criteria for Barrett dysplasia.