TY - JOUR
T1 - Neoplasia Detection Rate in Barrett's Esophagus and Its Impact on Missed Dysplasia
T2 - Results from a Large Population-Based Database
AU - Dhaliwal, Lovekirat
AU - Codipilly, D. Chamil
AU - Gandhi, Parth
AU - Johnson, Michele L.
AU - Lansing, Ramona
AU - Wang, Kenneth K.
AU - Leggett, Cadman L.
AU - Katzka, David A.
AU - Iyer, Prasad G.
N1 - Funding Information:
Funding Supported in part by the National Cancer Institute (RO1 CA241164 to PGI) and the National Institute of Aging (R01AG034676).
Funding Information:
Funding Supported in part by the National Cancer Institute (RO1 CA241164 to PGI) and the National Institute of Aging (R01AG034676).This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under award number R01AG034676. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Lovekirat Dhaliwal, BS (Writing – original draft: Equal), D. Chamil Codipilly, MD (Data curation: Equal), Parth Gandhi, Undergraduate (Data curation: Equal), Michele Johnson, BS (Data curation: Equal), Ramona Lansing, BS (Data curation: Equal), Kenneth Wang, MD (Investigation: Equal), Cadman Leggett, MD (Investigation: Equal), Katzka David, MD (Investigation: Equal), Prasad G. Iyer, MD, MS (Investigation: Equal; Writing – original draft: Equal; Writing – review & editing: Equal) Conflicts of interest These authors disclose the following: Cadman Leggett has received research support but no direct monetary compensation from Nine Point Medical. David A. Katzka has received honorarium from Celgene and Education Advisory Board of Takeda. Prasad G. Iyer has received research funding from Exact Sciences, Medtronic, Pentax Medical, and Nine Point Medical and consulting fees from Pentax Medical, CSA Medical, and Medtronic. The remaining authors disclose no conflicts.
Funding Information:
This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under award number R01AG034676. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
Conflicts of interest These authors disclose the following: Cadman Leggett has received research support but no direct monetary compensation from Nine Point Medical. David A. Katzka has received honorarium from Celgene and Education Advisory Board of Takeda. Prasad G. Iyer has received research funding from Exact Sciences, Medtronic, Pentax Medical, and Nine Point Medical and consulting fees from Pentax Medical, CSA Medical, and Medtronic. The remaining authors disclose no conflicts.
Publisher Copyright:
© 2021 AGA Institute
PY - 2021/5
Y1 - 2021/5
N2 - Background & Aims: It is a challenge to detect dysplasia in Barrett's esophagus (BE) and esophageal adenocarcinomas (EACs) are missed in 25%–33% of cases. The neoplasia detection rate (NDR), defined as the rate of high-grade dysplasia (HGD) or EAC detection during initial surveillance endoscopy, has been proposed as a quality metric for endoscopic evaluation of patients with BE. However, current estimates are from referral center cohorts, which might overestimate NDR. Effects on rates of missed dysplasia are also unknown. We analyzed data from a large cohort of patients with BE to estimate the NDR and factors associated with it, and assess the effects of the NDR on the rate of missed dysplasia. Methods: We analyzed data from 1066 patients in the Rochester Epidemiology Project-linked medical record system, a population-based cohort of patients with BE (confirmed by review of the endoscopic and histologic reports) from 11 southeastern Minnesota counties from 1991 through 2019. Biopsies reported to contain dysplasia were confirmed by expert gastrointestinal pathologists. The NDR was calculated as the rate of HGD or EAC detected by histologic analyses of biopsies collected during the first surveillance endoscopy. Patients without HGD or EAC at their initial endoscopy (n = 391) underwent repeat endoscopy within 12 months; HGD or EAC detected at the repeat endoscopy were considered to be missed on index endoscopy. Factors associated with NDR and missed dysplasia were identified using univariate and multivariate logistic regression models. Results: The NDR was 4.9% (95% CI, 3.8–6.4); 3.1% of patients had HGD, 1.8% had EAC, and 10.6% had low-grade dysplasia. Factors associated with higher rates of detection of neoplasia included older age, male sex, smoking, increasing length of BE, and surveillance endoscopies by gastroenterologists. This NDR was associated with a substantially lower rate of missed dysplasia (13%). Conclusions: In an analysis of 1066 patients with BE in a population-based cohort, we found a lower NDR and lower rate of missed dysplasia than previously reported. NDR may have value as a quality metric in BE surveillance if validated in other cohorts.
AB - Background & Aims: It is a challenge to detect dysplasia in Barrett's esophagus (BE) and esophageal adenocarcinomas (EACs) are missed in 25%–33% of cases. The neoplasia detection rate (NDR), defined as the rate of high-grade dysplasia (HGD) or EAC detection during initial surveillance endoscopy, has been proposed as a quality metric for endoscopic evaluation of patients with BE. However, current estimates are from referral center cohorts, which might overestimate NDR. Effects on rates of missed dysplasia are also unknown. We analyzed data from a large cohort of patients with BE to estimate the NDR and factors associated with it, and assess the effects of the NDR on the rate of missed dysplasia. Methods: We analyzed data from 1066 patients in the Rochester Epidemiology Project-linked medical record system, a population-based cohort of patients with BE (confirmed by review of the endoscopic and histologic reports) from 11 southeastern Minnesota counties from 1991 through 2019. Biopsies reported to contain dysplasia were confirmed by expert gastrointestinal pathologists. The NDR was calculated as the rate of HGD or EAC detected by histologic analyses of biopsies collected during the first surveillance endoscopy. Patients without HGD or EAC at their initial endoscopy (n = 391) underwent repeat endoscopy within 12 months; HGD or EAC detected at the repeat endoscopy were considered to be missed on index endoscopy. Factors associated with NDR and missed dysplasia were identified using univariate and multivariate logistic regression models. Results: The NDR was 4.9% (95% CI, 3.8–6.4); 3.1% of patients had HGD, 1.8% had EAC, and 10.6% had low-grade dysplasia. Factors associated with higher rates of detection of neoplasia included older age, male sex, smoking, increasing length of BE, and surveillance endoscopies by gastroenterologists. This NDR was associated with a substantially lower rate of missed dysplasia (13%). Conclusions: In an analysis of 1066 patients with BE in a population-based cohort, we found a lower NDR and lower rate of missed dysplasia than previously reported. NDR may have value as a quality metric in BE surveillance if validated in other cohorts.
KW - Accuracy
KW - Disease Progression
KW - Esophageal Cancer
KW - Pathology
UR - http://www.scopus.com/inward/record.url?scp=85095777710&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85095777710&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2020.07.034
DO - 10.1016/j.cgh.2020.07.034
M3 - Article
C2 - 32707339
AN - SCOPUS:85095777710
SN - 1542-3565
VL - 19
SP - 922-929.e1
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 5
ER -