The Role of Quantitative Pathology in Clinical Decision Making for Barrett’s Oesophagus

Intestinal-type columnar epithelium in the (distal) oesophagus, known as Barrett’s oesophagus (BO), is a well-defined premalignant condition [32]. The risk for the development of oesophageal adenocarcinoma in a patient with BO is at least 30 times higher as compared to the general population [9]. Invasive cancer in BO, so called Barrett cancer, is preceded by stages of progressively severe dysplastic changes [24]. For a symptomatic Barrett cancer, long-term survival rates are low. Therefore, attention should be focused on early detection of neoplastic changes, preferably in a preinvasive phase, i.e. dysplasia. An accurate and reproducible diagnosis of dysplasia in BO might ultimately lead to targeted therapeutic interventions or cancer prevention in the future. At present, dysplasia in BO is the only clinically accepted marker of neoplastic potential. Strategies for endoscopic surveillance of BO are dictated by the grade of dysplasia on endoscopic biopsy [17,23]. When a diagnosis of low-grade dysplasia is made, surveillance should be intensified by shortening the time intervals between consecutive endoscopies and by applying more aggressive biopsy sampling [35,36]. High-grade dysplasia may indicate imminent progression into invasive carcinoma or even its occult presence [1,5,10,18,27,30]. When the diagnosis of (persis