Controversies in the diagnosis of Barrett esophagus and Barrett-related dysplasia: one pathologist's perspective.

Abstract

athologists frequently assess esophageal biopsy specimens to “rule out Barrett esophagus,” as well as to assess for the presence or absence of dysplasia. To review some of the recent controversies in the diagnosis of Barrett esophagus and Barrett-related dysplasia. Sources were the author's experience and review of the English literature from 1978 to 2009. Although goblet cells are required by the American College of Gastroenterology to confirm a diagnosis of Barrett esophagus, this definition might expand to include columnar-lined esophagus without goblet cells. The recognition of dysplasia in Barrett esophagus remains a difficult task for the surgical pathologist, with difficulties in distinguishing reactive epithelium from dysplasia, low-grade dysplasia from high-grade dysplasia, and even high-grade dysplasia from intramucosal adenocarcinoma.