Dysplasia in Barrett's Esophagus

[@Swelandet92]

Wonderful presentation! I’m just wondering how you interpret low grade dysplasia that is located only to the crypts and doesn’t reach surface? Think you made an example of this at around 5:30... Do you in general just ignore it or do you do like deeper sections to see if it reaches the surface at some point? Then I also wonder if you routinely uses p53+Ki-67 to interpret dysplasia and your opinion about it. Best regards from Sweden

[@LewisHassell-OPEN]

Conventional intestinal type atypia of low grade confined to the crypts we ignore until it involves the surface in almost all cases. After ablation we comment since usually it is deep to squamous mucosa. Pyloric type dysplasia we comment on whether it makes it to the surface or not.

[@LewisHassell-OPEN]

How do you manage it in Sweden?

[@LewisHassell-OPEN]

We do not use IHC in the interpretation of esoph dysplasia routinely. One keeps hoping for reliable help on that but most of what has been touted ends up being insufficiently predictive.

[@Swelandet92]

Lewis Hassell well the reason why I ask is because there have been different opinions on how to handle atypia of low grade confined to the crypts in conventional intestinal type in my lab. Some reports it as low grade meanwhile some doesn’t and some do it if it also show expression of p53 and increase in Ki67. I’m working at a regional hospital with quite few pathologist but we also have consultants working on distance digitally which we can’t really discuss consensus with. Our national quality documents refers to WHO and many interpret it differently. I quote here for example... Like inflammatory bowel disease, dysplasia can sometimes be detected in early stage, when it is still restricted to the bases of the crypts; such cases are referred to as crypt dysplasia.... This caused some confusion and also the significance of p53. When it comes to pyloric type we report as you do. Thank you again for so many fantastic videos!