Barrett's Adenocarcinomas are frequently underdiagnosed as "high grade intraepithelial neoplasia"

Relevant guidelines require that a primary histological diagnosis of high-grade intraepithelial neoplasia (HGIEN) in Barrett's oesophagus, be submitted to a second opinion by an expert gastroenterological pathologist. To date, however, no pertinent study of the outcome of such second-opinion diagnoses has been published.

Between 2001 and 2005, histological slides from 275 patients with the primary diagnosis HGIEN underwent a second-opinion review. The resulting diagnoses were checked by follow-up in 207 of these patients (75.3 %).

The second-opinion diagnosis no IEN (n = 27) was confirmed in 85.2 % of the cases, 7.4 % had LGIEN, 3.7 % had HGIEN or a well-differentiated Barrett's adenocarcinoma (BCA) (1 patient, each). In the single patient with the second-opinion diagnosis LGIEN, endoscopic resection revealed a well-differentiated BCA, Follow-up examinations confirmed the second-opinion diagnosis BCA in 5 out of 12 patients, in 1 patient no IEN was found, and 6 patients had a BCA. The second-opinion diagnosis BCA was confirmed by follow-up-examinations in 145 patients (86.8 %), in 12 patients (7.2 %) follow-up revealed HGIEN and in 10 no neoplasia.

The results of this study show that the demand for a second opinion from an expert gastroenterological pathologist is justified, and also that BCA is frequently underdiagnosed as HGIEN.