Distinction of high-grade intraepithelial neoplasia and invasive Barrett's adenocarcinoma

Grading of intraepithelial neoplasia and diagnosis of mucosal carcinoma in Barrett's esophagus provokes controversy when discussed because there is wide interobserver and intraobserver variation of such diagnoses. With new endoscopic techniques, it might become easier to target biopsies to the most relevant structural changes to achieve more-precise diagnoses. Nevertheless, the distinction between high-grade intraepithelial neoplasia and mucosal carcinoma is almost without clinical relevance because both lesions need to be removed endoscopically if it is proven that they are definitively limited to the mucosal level. Studies on the natural course" of high-grade intraepithelial neoplasia show that overdiagnoses and underdiagnoses occur at receipt of the surgical specimen. Our knowledge of diagnostic criteria should be increased. © 2006 Japan Esophageal Society and Springer-Verlag."