Predictors of progression to cancer in Barrett's esophagus: Baseline histology and flow cytometry identify low- and high-risk patient subsets

OBJECTIVE: Barrett's esophagus develops in 5-20% of patients with gastroeso phageal reflux disease and predisposes to esophageal adenocarcinoma. The va lue of endoscopic biopsy surveillance is questioned because most patients d o not develop cancer. Furthermore, observer variation in histological diagn osis makes validation of surveillance guidelines difficult because varying histological interpretations may lead to different estimated rates of progr ession. Thus, objective biomarkers need to be validated for use with histol ogy to stratify patients according to their risk for progression to cancer. METHODS: We prospectively evaluated patients using a systematic endoscopic biopsy protocol with baseline histological and flow cytometric abnormalitie s as predictors and cancer as the outcome. RESULTS: Among patients with negative, indefinite, or low-grade dysplasia, those with neither aneuploidy nor increased 4N fractions had a 0% 5-yr cumu lative cancer incidence compared with 28% for those with either aneuploidy or increased 4N. Patients with baseline increased 4N, aneuploidy, and high- grade dysplasia had 5-yr cancer incidences of 56%, 43%, and 59%, respective ly. Aneuploidy, increased 4N, or HGD were detected at baseline in all 35 pa tients who developed cancer within 5 yr. CONCLUSIONS: A systematic baseline endoscopic biopsy protocol using histolo gy and flow cytometry identifies subsets of patients with Barrett's esophag us at low and high risk for progression to cancer. Patients whose baseline biopsies are negative, indefinite, or low-grade displasia without increased 4N or aneuploidy may have surveillance deferred for up to 5 yr. Patients w ith cytometric abnormalities merit more frequent surveillance, and manageme nt of high-grade displasia can be individualized. (C) 2000 by Am. Cell. of Gastroenterology.