University of Oulu

Huhta, H., Melkko, J., Kuopio, T., Karttunen, T. J., & Helminen, O. (2022). Risk of progression in Barrett’s esophagus based on diagnoses of general and gastrointestinal pathologists. A retrospective case-control study from Northern and Central Finland. Scandinavian Journal of Gastroenterology, 57(9), 1024–1029.

Risk of progression in Barrett’s esophagus based on diagnoses of general and gastrointestinal pathologists : a retrospective case-control study from Northern and Central Finland

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Author: Huhta, Heikki1,2; Melkko, Jukka3; Kuopio, Teijo4;
Organizations: 1Surgery Research Unit, Cancer and Translational Medicine Research Unit, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
2Surgery Research Unit, Oulu University Hospital, Oulu, Finland
3Department of Pathology, Oulu University Hospital, Oulu, Finland
4Department of Pathology, Jyväskylä Central Hospital, Jyväskylä, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.8 MB)
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Language: English
Published: Informa, 2022
Publish Date: 2022-11-24


Background: Esophageal adenocarcinoma (EAC) is the sixth leading cause of cancer-related death worldwide. It develops through Barrett’s metaplasia — dysplasia sequence. However, the effectiveness of endoscopic surveillance is limited, since diagnosis of low-grade dysplasia (LGD) is known to be challenging for pathologists. Our aim was to compare the risk of Barrett’s progression based on diagnoses of general and expert gastrointestinal (GI) pathologists in a population-based cohort.

Methods: A total of 60 patients with non-dysplastic metaplasia (BE) or LGD progressing to high grade dysplasia (HGD) or EAC during follow-up could be identified in the population. For comparison, series representing non-progressive BE (n = 56) and LGD cases (n = 54), matched for age, gender, and length of follow-up were collected. All available original HE stained slides (n = 292) were blindly re-evaluated by two experienced GI pathologists and patient groups of progressive non-progressive BE and LGD were formed according to revised diagnoses.

Results: Original diagnosis for each sample was changed in 25% of BE, 59% of LGD, and 33% of HGD diagnoses. Of the original LGD diagnoses, 53% were downgraded to BE or indefinite for dysplasia (ID). Of LGD diagnoses made by an expert GI pathologist, 61% were in the progressive LGD group, whereas only 42% of general pathologists’ LGD diagnoses were in the progressive LGD group.

Conclusion: Based on this retrospective case-control study, LGD is strongly over-diagnosed among general pathologists. LGD diagnosed by expert GI pathologists predicts progressive disease. Recommendation for consensus diagnosis by expert GI pathologists is justified also in the Finnish population-based setting.

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Series: Scandinavian journal of gastroenterology
ISSN: 0036-5521
ISSN-E: 1502-7708
ISSN-L: 0036-5521
Volume: 57
Issue: 9
Pages: 1024 - 1029
DOI: 10.1080/00365521.2022.2063033
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Funding: This work was supported by grants from The Finnish Cultural Foundation (Huhta), Vieno and Alli Suorsa Healthcare Foundation (Huhta), Georg C. and Mary Ehrnrooth Foundation, Finnish State Research Fund (Huhta, Helminen) and Instrumentarium Science Foundation (Helminen).
Copyright information: © 2022 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.