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

Arch Pathol Lab Med. 2010 Oct;134(10):1479-84. doi: 10.5858/2010-0249-RA.1.


Context: athologists frequently assess esophageal biopsy specimens to “rule out Barrett esophagus,” as well as to assess for the presence or absence of dysplasia.

Objective: To review some of the recent controversies in the diagnosis of Barrett esophagus and Barrett-related dysplasia.

Data sources: Sources were the author's experience and review of the English literature from 1978 to 2009.

Conclusions: 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.

Publication types

  • Review

MeSH terms

  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / pathology
  • Barrett Esophagus / diagnosis
  • Barrett Esophagus / pathology*
  • Biopsy
  • Diagnosis, Differential
  • Esophageal Neoplasms / diagnosis
  • Esophageal Neoplasms / pathology*
  • Esophagus / pathology
  • Goblet Cells / pathology
  • Humans
  • Observer Variation
  • Selection Bias