Materiały źródłowe

• #1 Predictors of Progression in Barrett’s Esophagus: Current Knowledge and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3408387/

  Barretts esophagus is the strongest risk for esophageal adenocarcinoma (EAC), a malignancy with persistently poor long-term outcomes. […] Identification of factors predicting progression to EAC would help in focusing surveillance, chemoprevention or ablation at those deemed to be at highest risk of progression. […] Clinical and demographic factors (age, male gender, length of BE segment) are associated with modestly increased odds of progression to EAC in some studies. […] Biomarkers such as aneuploidy and p53 loss of heterozygosity have been associated with increased risk of progression to high-grade dysplasia and / or EAC in single center prospective cohort studies. […] Development of a comprehensive BE risk progression score comprised of both clinical and biomarker variables should be the ultimate goal and can be achieved by multicenter prospective collaborative efforts.

• #2 Diagnostic and predictive biomarkers for Barrett’s esophagus: a narrative review – Di – Digestive Medicine Research

  https://dmr.amegroups.org/article/view/7106/html

  Barretts esophagus (BE) is widely recognized as the precursor lesion for esophageal adenocarcinoma (EAC). The importance of EAC lies in its 6-fold rising incidence over the past 40 years, and its dismal prognosis with the 5-year survival estimated to be only 10-15%. Because of the poor prognosis of EAC, its mainstay of management remains early detection and treatment of its precursor lesions, namely BE and its associated dysplasia. […] Although BE is the most important risk factor for the development of EAC, the estimated risk of progression from BE to EAC is only 0.1-2% per annum. As it is not possible clinically to predict which BE will progress to neoplasia, and which will not progress to neoplasm, it may be prudent for clinicians to rely upon biomarkers to select those who are at risk for more intensive surveillance and if warranted pre-emptive treatment.

• #3 Understanding Barrett’s Esophagus Diagnosis and Cancer Risk

  https://castlebiosciences.com/patient-information/gastroenterology/barretts-esophagus/overview

  Barretts esophagus is considered a precancerous condition, because it can progress into esophageal adenocarcinoma, commonly known as esophageal cancer. […] An estimated 5% of people with Barretts esophagus will develop esophageal cancer over the course of their lifetime. While the chances of Barrett’s esophagus becoming cancer are relatively low, the consequences of developing esophageal cancer are very high. The cancer is highly lethal after symptom onset, with less than 20% of patients surviving beyond five years. […] Barretts esophagus is the only known precursor to esophageal adenocarcinoma, and unlike esophageal cancer, Barrett’s esophagus is highly curable and treatment is minimally invasive. […] Because of this, the primary method of preventing esophageal adenocarcinoma is screening for Barretts esophagus and treating precancerous tissue before it can progress to cancer.

• #4 Esophageal adenocarcinoma: A dire need for early detection and treatment | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/5/269

  Esophageal adenocarcinoma has a favorable prognosis if diagnosed early, when it is isolated to the mucosal and submucosal layers of the esophagus. Unfortunately, most cases are diagnosed at a late stage, when the prognosis is dismal. The 5-year overall survival rate of patients with esophageal adenocarcinoma is less than 20%, comparable to that of patients who have liver, lung, or pancreas cancer. Thus, there is a dire need for effective screening strategies to diagnose it earlier. […] In a prospective study, when patients with Barrett esophagus underwent endoscopic surveillance, the cases of esophageal cancer that arose were diagnosed at an earlier stage than in the general population. However, studies have failed to identify an accurate, cost-effective, widely applicable tool that can lower the mortality rate.

• #5 Diagnostic and predictive biomarkers for Barrett’s esophagus: a narrative review – Di – Digestive Medicine Research

  https://dmr.amegroups.org/article/view/7106/html

  Barretts esophagus (BE) is widely recognized as the precursor lesion for esophageal adenocarcinoma (EAC). The importance of EAC lies in its 6-fold rising incidence over the past 40 years, and its dismal prognosis with the 5-year survival estimated to be only 10-15%. Because of the poor prognosis of EAC, its mainstay of management remains early detection and treatment of its precursor lesions, namely BE and its associated dysplasia. […] Although BE is the most important risk factor for the development of EAC, the estimated risk of progression from BE to EAC is only 0.1-2% per annum. As it is not possible clinically to predict which BE will progress to neoplasia, and which will not progress to neoplasm, it may be prudent for clinicians to rely upon biomarkers to select those who are at risk for more intensive surveillance and if warranted pre-emptive treatment.

• #6 Understanding Barrett’s Esophagus Diagnosis and Cancer Risk

  https://castlebiosciences.com/patient-information/gastroenterology/barretts-esophagus/overview

  Barretts esophagus is considered a precancerous condition, because it can progress into esophageal adenocarcinoma, commonly known as esophageal cancer. […] An estimated 5% of people with Barretts esophagus will develop esophageal cancer over the course of their lifetime. While the chances of Barrett’s esophagus becoming cancer are relatively low, the consequences of developing esophageal cancer are very high. The cancer is highly lethal after symptom onset, with less than 20% of patients surviving beyond five years. […] Barretts esophagus is the only known precursor to esophageal adenocarcinoma, and unlike esophageal cancer, Barrett’s esophagus is highly curable and treatment is minimally invasive. […] Because of this, the primary method of preventing esophageal adenocarcinoma is screening for Barretts esophagus and treating precancerous tissue before it can progress to cancer.

• #7 Barrett’s Esophagus: Symptoms, Causes, Treatments & Medications

  https://my.clevelandclinic.org/health/diseases/14432-barretts-esophagus

  Because of the small chance it might progress to esophageal cancer, healthcare providers like to keep an eye on Barretts esophagus. But the risk is only about half a percent per year. […] If you remove the affected tissue and stop whatever was injuring your esophagus, Barretts esophagus may be cured. But it can return. […] In general, your prognosis (outlook) is better the sooner you seek treatment. You can prevent and even remove cancerous changes if you catch them early enough.

• #8 Predictors of Progression in Barrett’s Esophagus: Current Knowledge and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3408387/

  Though challenging, creation of such a score has the potential to improve outcomes and make the management of patients with BE more cost effective. […] The long-term survival of patients with EAC who present with symptoms remains dismal. […] This evidence from retrospective studies found that patients diagnosed with EAC in BE surveillance programs may have better survival than those diagnosed after the onset of symptoms has led to recommendations for the endoscopic surveillance of patients diagnosed with BE to detect progression to dysplasia and / or EAC. […] The potentially large number of patients with BE, which makes the estimate of subjects requiring surveillance run into millions in the United States, is one of many barriers to efficient and effective surveillance. […] Despite multiple limitations, the grade of dysplasia remains the most widely used tool to assess the risk of progression in BE.

• #9 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Currently, dysplasia is the primary clinical biomarker used for risk assessment in the surveillance and management of BE patients. […] The rationale for its use as the primary clinical biomarker is based on the premise that EAC in BE patients develops through a sequence of molecular and morphologic changes that begin with intestinal metaplasia and then progress from LGD to HGD, and ultimately to EAC. […] While the annual cancer risk for NDBE patients is low (0.10.5% per year), HGD is considered a key premalignant step that is associated with a greater risk of either already having EAC or developing it on follow-up (16100%). […] The natural history of LGD is more controversial, with variable progression rates ranging from 0.4 to 13.4% per year. […] Unfortunately, dysplasia has a number of limitations as a biomarker.

• #10 Predictors of Progression in Barrett’s Esophagus: Current Knowledge and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3408387/

  However, surveillance of all patients with BE remains an expensive and not a cost-effective proposition. […] Assessment of the current knowledge gaps would be of crucial importance in devising a future road map for the development of a practical, cost-effective and widely applicable tool for the risk stratification of patients with BE. […] The grade of dysplasia continues to be the bedrock of risk stratification in patients with BE. […] The currently accepted paradigm attempts to correlate the risk of progression to the grade of dysplasia based on circumstantial evidence that progression occurs in an orderly fashion from no dysplasia to LGD to HGD followed by EAC. […] The reported rate of progression to EAC in patients with LGD has varied from 0.61.2% per year. […] A recent meta-analysis reported that the rate of progression to EAC in LGD was 16.98/1,000 person-years compared with 5.98/1,000 person-years in subjects with no dysplasia, but there was significant heterogeneity between the studies.

• #11 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Currently, dysplasia is the primary clinical biomarker used for risk assessment in the surveillance and management of BE patients. […] The rationale for its use as the primary clinical biomarker is based on the premise that EAC in BE patients develops through a sequence of molecular and morphologic changes that begin with intestinal metaplasia and then progress from LGD to HGD, and ultimately to EAC. […] While the annual cancer risk for NDBE patients is low (0.10.5% per year), HGD is considered a key premalignant step that is associated with a greater risk of either already having EAC or developing it on follow-up (16100%). […] The natural history of LGD is more controversial, with variable progression rates ranging from 0.4 to 13.4% per year. […] Unfortunately, dysplasia has a number of limitations as a biomarker.

• #12 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Subsequently, there is greater emphasis on optimization of the diagnosis of dysplasia as well as identification of patients who are more likely to progress to HGD/EAC and/or have a poor response to endoscopic therapy. […] However, considering the annual cancer risk for patients with non-dysplastic BE (NDBE) is low (0.10.5% per year), identification of reliable biomarkers of low risk to allow prolongation of surveillance intervals compared with the current recommendations of repeating endoscopy every 35 years in those with NDBE remains an important goal of biomarker research. […] In fact, there is evidence that the current surveillance protocols may not be effective in reducing mortality from EAC, with one study demonstrating that patients with fatal disease were nearly as likely to have received surveillance (55%) as were controls (60%).

• #13 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Currently, dysplasia is the primary clinical biomarker used for risk assessment in the surveillance and management of BE patients. […] The rationale for its use as the primary clinical biomarker is based on the premise that EAC in BE patients develops through a sequence of molecular and morphologic changes that begin with intestinal metaplasia and then progress from LGD to HGD, and ultimately to EAC. […] While the annual cancer risk for NDBE patients is low (0.10.5% per year), HGD is considered a key premalignant step that is associated with a greater risk of either already having EAC or developing it on follow-up (16100%). […] The natural history of LGD is more controversial, with variable progression rates ranging from 0.4 to 13.4% per year. […] Unfortunately, dysplasia has a number of limitations as a biomarker.

• #14 Predictors of Progression in Barrett’s Esophagus: Current Knowledge and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3408387/

  However, surveillance of all patients with BE remains an expensive and not a cost-effective proposition. […] Assessment of the current knowledge gaps would be of crucial importance in devising a future road map for the development of a practical, cost-effective and widely applicable tool for the risk stratification of patients with BE. […] The grade of dysplasia continues to be the bedrock of risk stratification in patients with BE. […] The currently accepted paradigm attempts to correlate the risk of progression to the grade of dysplasia based on circumstantial evidence that progression occurs in an orderly fashion from no dysplasia to LGD to HGD followed by EAC. […] The reported rate of progression to EAC in patients with LGD has varied from 0.61.2% per year. […] A recent meta-analysis reported that the rate of progression to EAC in LGD was 16.98/1,000 person-years compared with 5.98/1,000 person-years in subjects with no dysplasia, but there was significant heterogeneity between the studies.

• #15 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Currently, dysplasia is the primary clinical biomarker used for risk assessment in the surveillance and management of BE patients. […] The rationale for its use as the primary clinical biomarker is based on the premise that EAC in BE patients develops through a sequence of molecular and morphologic changes that begin with intestinal metaplasia and then progress from LGD to HGD, and ultimately to EAC. […] While the annual cancer risk for NDBE patients is low (0.10.5% per year), HGD is considered a key premalignant step that is associated with a greater risk of either already having EAC or developing it on follow-up (16100%). […] The natural history of LGD is more controversial, with variable progression rates ranging from 0.4 to 13.4% per year. […] Unfortunately, dysplasia has a number of limitations as a biomarker.

• #16 Predictors of Progression in Barrett’s Esophagus: Current Knowledge and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3408387/

  Though there is a better consensus on the rate of progression of HGD to EAC, the reported rates of progression to EAC in patients with HGD varies from 16% over 7 years to over 50% in 5 years. […] In summary, the grade of dysplasia is an imperfect but perhaps the most widely used and accepted marker for risk stratification in BE.

• #17 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Currently, dysplasia is the primary clinical biomarker used for risk assessment in the surveillance and management of BE patients. […] The rationale for its use as the primary clinical biomarker is based on the premise that EAC in BE patients develops through a sequence of molecular and morphologic changes that begin with intestinal metaplasia and then progress from LGD to HGD, and ultimately to EAC. […] While the annual cancer risk for NDBE patients is low (0.10.5% per year), HGD is considered a key premalignant step that is associated with a greater risk of either already having EAC or developing it on follow-up (16100%). […] The natural history of LGD is more controversial, with variable progression rates ranging from 0.4 to 13.4% per year. […] Unfortunately, dysplasia has a number of limitations as a biomarker.

• #18 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Consequently, both the American College of Gastroenterology and the American Gastroenterological Association strongly recommend that all potential dysplasia cases be confirmed by at least one experienced GI pathologist before embarking on a management plan. […] Overall, these results suggest that additional or alternative biomarker(s) may be useful to better risk stratify BE patients. […] The objective of TissueCypher is to evaluate samples from BE patients diagnosed as negative for dysplasia, IND, or LGD on routine histologic evaluation to identify those patients most likely to progress to HGD/EAC so that intensified screening or ablation can be offered to them. […] The biggest appeal of ML assessment is that it allows a direct correlation with morphology and provides an objective quantitative measure of the presence and extent of molecular alterations associated with development of dysplasia and EAC, eliminating human interobserver variability.

• #19 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Subsequently, there is greater emphasis on optimization of the diagnosis of dysplasia as well as identification of patients who are more likely to progress to HGD/EAC and/or have a poor response to endoscopic therapy. […] However, considering the annual cancer risk for patients with non-dysplastic BE (NDBE) is low (0.10.5% per year), identification of reliable biomarkers of low risk to allow prolongation of surveillance intervals compared with the current recommendations of repeating endoscopy every 35 years in those with NDBE remains an important goal of biomarker research. […] In fact, there is evidence that the current surveillance protocols may not be effective in reducing mortality from EAC, with one study demonstrating that patients with fatal disease were nearly as likely to have received surveillance (55%) as were controls (60%).

• #20 Diagnostic and predictive biomarkers for Barrett’s esophagus: a narrative review – Di – Digestive Medicine Research

  https://dmr.amegroups.org/article/view/7106/html

  One seminal study confirmed p53 as a clinically pertinent predictor of neoplastic progression of BE, showing the overall OR for intense overexpression of p53 in NDBE, and LGD to be 6.1, and 8.6, respectively. Cyclin A has also been considered as a reliable predictive biomarker for neoplastic progression. Its overall OR for predicting neoplastic progression in BE patients is estimated at 1.9. […] During the malignant transformation of BE, microRNA expression appeared to be up-regulated or down-regulated. The up-regulation of miRNA expression is mainly concentrated in microRNA-205, 203, 133-a, 21, 25, and 223, while down-regulation occurs mainly in microRNA-375. These markers, together with microRNA 100, 145, 148, 149, 199a-5p, 29c-3p, 27b, 126, and 143 have been proposed as potentially useful prognostic biomarkers. In other studies, higher expression of microRNA-192, 194, 196a, and 196b are observed in BE patients with progression to EAC than those who do not progress to EAC. […] The ultimate goal is for these biomarkers to serve as important tools for clinicians to make an accurate diagnosis of BE, early diagnosis and eradication of BE-related neoplasia, and risk stratify the risk lesions so that they can benefit from intensive surveillance, and pre-emptive treatment.

• #21 The Aberrant Expression of Biomarkers and Risk Prediction for Neoplastic Changes in Barrett’s Esophagus–Dysplasia

  https://www.mdpi.com/2072-6694/16/13/2386

  The aberrant expressions of p53 and p16 in BE-indefinite dysplasia (IND) progressor cohorts predicted the risk of progression. […] Aberrant p16 expression is significantly associated with LGD, HGD, and EAC histology with 10.8 RR, 90% sensitivity, and 87% specificity. […] The overexpression of p53 was identified in all categories of BE-associated dysplasia but the degree of aberrant expression increased with the progression of dysplasia. […] Overall, aberrant p53 expression seems to serve as a marker for the likelihood of progression to HGD/EAC. […] The findings in our study support those of previous studies. […] The aberrant expression of one or a combination of useful biomarkers with high sensitivity and specificity, such as cyclin D1, MCM2, p16, beta-catenin, Ki-67, and p53, appears to be suitable for use in a routine test in a clinical laboratory. […] The British Society of Gastroenterology recommends assessing TP53 using IHC to solve the issue of equivocal histologic diagnoses of dysplasia, reflexively adding this to routine practice.

• #22 The Aberrant Expression of Biomarkers and Risk Prediction for Neoplastic Changes in Barrett’s Esophagus–Dysplasia

  https://www.mdpi.com/2072-6694/16/13/2386

  The aberrant expressions of p53 and p16 in BE-indefinite dysplasia (IND) progressor cohorts predicted the risk of progression. […] Aberrant p16 expression is significantly associated with LGD, HGD, and EAC histology with 10.8 RR, 90% sensitivity, and 87% specificity. […] The overexpression of p53 was identified in all categories of BE-associated dysplasia but the degree of aberrant expression increased with the progression of dysplasia. […] Overall, aberrant p53 expression seems to serve as a marker for the likelihood of progression to HGD/EAC. […] The findings in our study support those of previous studies. […] The aberrant expression of one or a combination of useful biomarkers with high sensitivity and specificity, such as cyclin D1, MCM2, p16, beta-catenin, Ki-67, and p53, appears to be suitable for use in a routine test in a clinical laboratory. […] The British Society of Gastroenterology recommends assessing TP53 using IHC to solve the issue of equivocal histologic diagnoses of dysplasia, reflexively adding this to routine practice.

• #23 Diagnostic and predictive biomarkers for Barrett’s esophagus: a narrative review – Di – Digestive Medicine Research

  https://dmr.amegroups.org/article/view/7106/html

  One seminal study confirmed p53 as a clinically pertinent predictor of neoplastic progression of BE, showing the overall OR for intense overexpression of p53 in NDBE, and LGD to be 6.1, and 8.6, respectively. Cyclin A has also been considered as a reliable predictive biomarker for neoplastic progression. Its overall OR for predicting neoplastic progression in BE patients is estimated at 1.9. […] During the malignant transformation of BE, microRNA expression appeared to be up-regulated or down-regulated. The up-regulation of miRNA expression is mainly concentrated in microRNA-205, 203, 133-a, 21, 25, and 223, while down-regulation occurs mainly in microRNA-375. These markers, together with microRNA 100, 145, 148, 149, 199a-5p, 29c-3p, 27b, 126, and 143 have been proposed as potentially useful prognostic biomarkers. In other studies, higher expression of microRNA-192, 194, 196a, and 196b are observed in BE patients with progression to EAC than those who do not progress to EAC. […] The ultimate goal is for these biomarkers to serve as important tools for clinicians to make an accurate diagnosis of BE, early diagnosis and eradication of BE-related neoplasia, and risk stratify the risk lesions so that they can benefit from intensive surveillance, and pre-emptive treatment.

• #24 Diagnostic and predictive biomarkers for Barrett’s esophagus: a narrative review – Di – Digestive Medicine Research

  https://dmr.amegroups.org/article/view/7106/html

  One seminal study confirmed p53 as a clinically pertinent predictor of neoplastic progression of BE, showing the overall OR for intense overexpression of p53 in NDBE, and LGD to be 6.1, and 8.6, respectively. Cyclin A has also been considered as a reliable predictive biomarker for neoplastic progression. Its overall OR for predicting neoplastic progression in BE patients is estimated at 1.9. […] During the malignant transformation of BE, microRNA expression appeared to be up-regulated or down-regulated. The up-regulation of miRNA expression is mainly concentrated in microRNA-205, 203, 133-a, 21, 25, and 223, while down-regulation occurs mainly in microRNA-375. These markers, together with microRNA 100, 145, 148, 149, 199a-5p, 29c-3p, 27b, 126, and 143 have been proposed as potentially useful prognostic biomarkers. In other studies, higher expression of microRNA-192, 194, 196a, and 196b are observed in BE patients with progression to EAC than those who do not progress to EAC. […] The ultimate goal is for these biomarkers to serve as important tools for clinicians to make an accurate diagnosis of BE, early diagnosis and eradication of BE-related neoplasia, and risk stratify the risk lesions so that they can benefit from intensive surveillance, and pre-emptive treatment.

• #25 A personalized and dynamic risk estimation model: The new paradigm in Barrett’s esophagus surveillance | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0267503

  The current surveillance strategy in Barretts esophagus (BE) uses only histological findings of the last endoscopy to assess neoplastic progression risk. […] Longitudinal evolutions of aberrant expression of p53 (HR 1.26, p0.01) and SOX2 (HR 1.43, p0.01) were associated with an increased HGD/EAC risk. […] This study provides solid ground to further explore a paradigm shift from currently recommended fixed intervals towards personalized surveillance, in which tailored risk estimations and corresponding surveillance intervals can be updated at every FU endoscopy for individual BE patients. […] The risk of neoplastic progression was estimated based on the longitudinal evolution of LGD, p53, and SOX2. […] An increased risk of developing HGD/EAC during surveillance was associated with aberrant expression of p53 (HR value 1.26, p0.01) or SOX2 (HR value 1.43, p0.01).

• #26 Somatic whole genome dynamics of precancer in Barrett’s esophagus reveals features associated with disease progression | Nature Communications

  https://www.nature.com/articles/s41467-022-29767-7

  While the genomes of normal tissues undergo dynamic changes over time, little is understood about the temporal-spatial dynamics of genomes in premalignant tissues that progress to cancer compared to those that remain cancer-free. […] The critical distinction between stable Barretts versus those who progress to cancer is acquisition and expansion of TP53/ cell populations having complex structural variants and high-level amplifications, which are detectable up to six years prior to a cancer diagnosis. […] These findings reveal the timing of common somatic genome dynamics in stable Barretts esophagus and define key genomic features specific to progression to esophageal adenocarcinoma, both of which are critical for cancer prevention and early detection strategies. […] A key remaining question is defining molecular features, including somatic genomic dynamics, that can be used to stratify patients with BE at the highest risk of a cancer outcome (CO) vs. those likely to remain cancer free (noncancer outcome, NCO), and target those requiring aggressive treatment (ablation, endoscopic resection, surgery) vs. conservative monitoring for early detection of cancer.

• #27 Somatic whole genome dynamics of precancer in Barrett’s esophagus reveals features associated with disease progression | Nature Communications

  https://www.nature.com/articles/s41467-022-29767-7

  The importance of TP53 alterations to ESAD progression risk has been well established. […] Our study design further refines our understanding, showing the clonal expansion of TP53/ clones and development of complex structural variations are almost exclusive to CO patients and ESAD samples. […] Thus, while potentially pathogenic TP53 mutations were detected in non-progressing BE, they were generally subclonal, one-hit, and localized, compared to TP53 mutations detected in BE patients who progressed to ESAD.

• #28 Predictors of Progression in Barrett’s Esophagus: Current Knowledge and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3408387/

  Barretts esophagus is the strongest risk for esophageal adenocarcinoma (EAC), a malignancy with persistently poor long-term outcomes. […] Identification of factors predicting progression to EAC would help in focusing surveillance, chemoprevention or ablation at those deemed to be at highest risk of progression. […] Clinical and demographic factors (age, male gender, length of BE segment) are associated with modestly increased odds of progression to EAC in some studies. […] Biomarkers such as aneuploidy and p53 loss of heterozygosity have been associated with increased risk of progression to high-grade dysplasia and / or EAC in single center prospective cohort studies. […] Development of a comprehensive BE risk progression score comprised of both clinical and biomarker variables should be the ultimate goal and can be achieved by multicenter prospective collaborative efforts.

• #29

  https://link.springer.com/article/10.1007/s10620-015-3884-5

  Barretts esophagus (BE) is a common and important precursor lesion of esophageal adenocarcinoma (EAC). A third of patients with BE are asymptomatic, and our ability to predict the risk of progression of metaplasia to dysplasia and EAC (and therefore guide management) is limited. […] There is therefore an immediate clinical need for biomarkers to predict both susceptibility to BE and progression. […] The robustness of the associations between CIN and progression suggests it to be of immediate clinical utility. CIN is a constituent of genomic instability, a state of erroneous progression through the cell cycle. […] However, the overall evidence base is characterized by widespread methodological issues, which limit the immediate clinical utility of these markers. Consequently, larger studies with more robust design are required to validate these markers, identify novel variants, and incorporate them into clinical practice.

• #30 Three-Tiered Risk Stratification Model to Predict Progression in Barrett’s Esophagus Using Epigenetic and Clinical Features | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0001890

  Barrett’s esophagus predisposes to esophageal adenocarcinoma. However, the value of endoscopic surveillance in Barrett’s esophagus has been debated because of the low incidence of esophageal adenocarcinoma in Barrett’s esophagus. […] In this study, we developed a 3-tiered risk stratification strategy, based on systematically selected epigenetic and clinical parameters, to improve Barrett’s esophagus surveillance efficiency. […] This 3-tiered risk stratification strategy has the potential to exert a profound impact on Barrett’s esophagus surveillance accuracy and efficiency. […] Progression-free survivals differed significantly among the 3 risk groups, with p=0.0022 (HR vs. IR) and p0.0001 (HR or IR vs. LR). […] Three Kaplan-Meier curves showed a statistically significant difference in progression-free survival among the three risk tiers defined by the combined LDA model. The LR group had the best progression-free survival, significantly better than both the IR and HR groups (p0.0001, logrank test). The HR group had the worst progression-free survival, significantly shorter than both the IR (p=0.0022, logrank test) and LR groups. The IR group had a progression risk significantly different from the other 2 groups. Thus, these 3 specimen groups classified by the combined model assigned progression risk in a meaningful manner.

• #31 Three-Tiered Risk Stratification Model to Predict Progression in Barrett’s Esophagus Using Epigenetic and Clinical Features | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0001890

  Barrett’s esophagus predisposes to esophageal adenocarcinoma. However, the value of endoscopic surveillance in Barrett’s esophagus has been debated because of the low incidence of esophageal adenocarcinoma in Barrett’s esophagus. […] In this study, we developed a 3-tiered risk stratification strategy, based on systematically selected epigenetic and clinical parameters, to improve Barrett’s esophagus surveillance efficiency. […] This 3-tiered risk stratification strategy has the potential to exert a profound impact on Barrett’s esophagus surveillance accuracy and efficiency. […] Progression-free survivals differed significantly among the 3 risk groups, with p=0.0022 (HR vs. IR) and p0.0001 (HR or IR vs. LR). […] Three Kaplan-Meier curves showed a statistically significant difference in progression-free survival among the three risk tiers defined by the combined LDA model. The LR group had the best progression-free survival, significantly better than both the IR and HR groups (p0.0001, logrank test). The HR group had the worst progression-free survival, significantly shorter than both the IR (p=0.0022, logrank test) and LR groups. The IR group had a progression risk significantly different from the other 2 groups. Thus, these 3 specimen groups classified by the combined model assigned progression risk in a meaningful manner.

• #32 Three-Tiered Risk Stratification Model to Predict Progression in Barrett’s Esophagus Using Epigenetic and Clinical Features | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0001890

  The 2-year progression-free survival rates of HR, IR, and LR were 45%, 88.5%, and 97.8%, respectively. Four-year progression-free survival rates were 35%, 63.5%, and 93.5%, respectively. Differences in progression-free survival among these 3 risk tiers were statistically significant (log-rank test). […] In conclusion, we developed a 3-tiered risk stratification strategy for neoplastic progression prediction in BE patients, based on epigenetic and clinical parameters. This strategy offers considerable promise to benefit the current BE surveillance health care system.

• #33 A personalized and dynamic risk estimation model: The new paradigm in Barrett’s esophagus surveillance | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0267503

  The current surveillance strategy in Barretts esophagus (BE) uses only histological findings of the last endoscopy to assess neoplastic progression risk. […] Longitudinal evolutions of aberrant expression of p53 (HR 1.26, p0.01) and SOX2 (HR 1.43, p0.01) were associated with an increased HGD/EAC risk. […] This study provides solid ground to further explore a paradigm shift from currently recommended fixed intervals towards personalized surveillance, in which tailored risk estimations and corresponding surveillance intervals can be updated at every FU endoscopy for individual BE patients. […] The risk of neoplastic progression was estimated based on the longitudinal evolution of LGD, p53, and SOX2. […] An increased risk of developing HGD/EAC during surveillance was associated with aberrant expression of p53 (HR value 1.26, p0.01) or SOX2 (HR value 1.43, p0.01).

• #34 A personalized and dynamic risk estimation model: The new paradigm in Barrett’s esophagus surveillance | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0267503

  The predictive performance of this dynamic model was shown to be higher than the static model. […] This interval can vary per patient, but also per endoscopy within the same patient if new biomarker measurements are included and the neoplastic progression risk is updated. […] In conclusion, longitudinal evolutions of immunohistochemical biomarkers and, to a lesser extent, histological diagnosis are of great value in risk stratification to predict Barretts progression.

• #35 A personalized and dynamic risk estimation model: The new paradigm in Barrett’s esophagus surveillance | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0267503

  The current surveillance strategy in Barretts esophagus (BE) uses only histological findings of the last endoscopy to assess neoplastic progression risk. […] Longitudinal evolutions of aberrant expression of p53 (HR 1.26, p0.01) and SOX2 (HR 1.43, p0.01) were associated with an increased HGD/EAC risk. […] This study provides solid ground to further explore a paradigm shift from currently recommended fixed intervals towards personalized surveillance, in which tailored risk estimations and corresponding surveillance intervals can be updated at every FU endoscopy for individual BE patients. […] The risk of neoplastic progression was estimated based on the longitudinal evolution of LGD, p53, and SOX2. […] An increased risk of developing HGD/EAC during surveillance was associated with aberrant expression of p53 (HR value 1.26, p0.01) or SOX2 (HR value 1.43, p0.01).

• #36 Understanding Barrett’s Esophagus Diagnosis and Cancer Risk

  https://castlebiosciences.com/patient-information/gastroenterology/barretts-esophagus/overview

  Detecting and treating dysplastic Barretts esophagus is an extremely effective way to prevent esophageal adenocarcinoma. However, only treating patients who present with dysplastic Barretts esophagus can result in missing patients who progress to cancer rapidly. In fact, 50% of Barretts esophagus patients who develop cancer were initially treated as if they were low risk because no dysplasia was detected at diagnosis. […] TissueCypher is an artificial intelligence-driven, precision medicine test to predict the risk of progression from Barretts esophagus to cancer, which can identify patients that show no signs of dysplasia but are at high risk of progressing to cancer in the future.

• #37 Barrett’s Esophagus: New Tool Predicts the Risk of Cancer

  https://www.linkedin.com/pulse/barretts-esophagus-new-tool-predicts-risk-cancer-pat-salber-md-mba

  Cernostic’s TissueCypher Assay uses molecular and cellular data to predict which patients with Barrett’s Esophagus are at risk of progression to esophageal cancer. […] Overall, the five-year survival rate is ~20% although cancers diagnosed early have a better prognosis. […] But less than 1% of them will develop esophageal adenocarcinoma. […] A key clinical question is which of the three to four million people living with Barrett’s in the US alone will progress to esophageal adenocarcinoma (EAC)? […] The inability to determine that risk leaves gastroenterologists and their patients without complete information to determine the most clinically and cost-effective treatment. […] Cernostics is looking to change all that with their next generation cancer diagnostics and prognostics. […] Until now, there has been no adequate way to determine the risk level of patients with Barretts esophagus.

• #38 Barrett’s Esophagus: New Tool Predicts the Risk of Cancer

  https://www.linkedin.com/pulse/barretts-esophagus-new-tool-predicts-risk-cancer-pat-salber-md-mba

  The goal is to eliminate uncertainty related to the treatment of Barretts esophagus in patients who meet those criteria. […] The product will improve practice and treatment and its likely to be financially viable. […] The test gets all this protein expression information and its linked to specific geographies on the tumors. […] When the Assay calls a patient high risk typically the positive predictive value is that their progression rate per year is above 5% 6%. […] Weve been able to confirm through our research that our risk stratification has been accurate in identifying who goes on to develop esophageal cancer up to 7 years later and who does not. […] TissueCypher identified a high-risk subset of patients at 9.4x increased risk of progression to high-grade dysplasia or esophageal carcinoma within 5 years.

• #39 Barrett’s Esophagus: New Tool Predicts the Risk of Cancer

  https://www.linkedin.com/pulse/barretts-esophagus-new-tool-predicts-risk-cancer-pat-salber-md-mba

  The goal is to eliminate uncertainty related to the treatment of Barretts esophagus in patients who meet those criteria. […] The product will improve practice and treatment and its likely to be financially viable. […] The test gets all this protein expression information and its linked to specific geographies on the tumors. […] When the Assay calls a patient high risk typically the positive predictive value is that their progression rate per year is above 5% 6%. […] Weve been able to confirm through our research that our risk stratification has been accurate in identifying who goes on to develop esophageal cancer up to 7 years later and who does not. […] TissueCypher identified a high-risk subset of patients at 9.4x increased risk of progression to high-grade dysplasia or esophageal carcinoma within 5 years.

• #40 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Consequently, both the American College of Gastroenterology and the American Gastroenterological Association strongly recommend that all potential dysplasia cases be confirmed by at least one experienced GI pathologist before embarking on a management plan. […] Overall, these results suggest that additional or alternative biomarker(s) may be useful to better risk stratify BE patients. […] The objective of TissueCypher is to evaluate samples from BE patients diagnosed as negative for dysplasia, IND, or LGD on routine histologic evaluation to identify those patients most likely to progress to HGD/EAC so that intensified screening or ablation can be offered to them. […] The biggest appeal of ML assessment is that it allows a direct correlation with morphology and provides an objective quantitative measure of the presence and extent of molecular alterations associated with development of dysplasia and EAC, eliminating human interobserver variability.

• #41 Predictors of Progression in Barrett’s Esophagus: Current Knowledge and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3408387/

  Barretts esophagus is the strongest risk for esophageal adenocarcinoma (EAC), a malignancy with persistently poor long-term outcomes. […] Identification of factors predicting progression to EAC would help in focusing surveillance, chemoprevention or ablation at those deemed to be at highest risk of progression. […] Clinical and demographic factors (age, male gender, length of BE segment) are associated with modestly increased odds of progression to EAC in some studies. […] Biomarkers such as aneuploidy and p53 loss of heterozygosity have been associated with increased risk of progression to high-grade dysplasia and / or EAC in single center prospective cohort studies. […] Development of a comprehensive BE risk progression score comprised of both clinical and biomarker variables should be the ultimate goal and can be achieved by multicenter prospective collaborative efforts.

• #42 Prediction of Barrett’s Esophagus Among Men

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3903120/

  Barretts esophagus was found in 70 (8.5%) of 822 CRC screenees. […] The prevalence of Barretts esophagus was substantial in our population of older overweight men. […] A model based on GERD, age, abdominal obesity, and cigarette use more accurately classified the presence of Barretts esophagus than did a model based on GERD alone. […] We created a prediction tool, which had a NRI index of ~20% for classifying the probability of Barretts esophagus compared with a model based on GERD frequency and duration alone. […] Our novel prediction tool more accurately classifies the presence of Barretts esophagus than does a model based on GERD symptom frequency and duration alone.

• #43 Prediction of Barrett’s Esophagus Among Men

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3903120/

  Barretts esophagus was found in 70 (8.5%) of 822 CRC screenees. […] The prevalence of Barretts esophagus was substantial in our population of older overweight men. […] A model based on GERD, age, abdominal obesity, and cigarette use more accurately classified the presence of Barretts esophagus than did a model based on GERD alone. […] We created a prediction tool, which had a NRI index of ~20% for classifying the probability of Barretts esophagus compared with a model based on GERD frequency and duration alone. […] Our novel prediction tool more accurately classifies the presence of Barretts esophagus than does a model based on GERD symptom frequency and duration alone.

• #44 Esophageal adenocarcinoma: A dire need for early detection and treatment | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/5/269

  Current guidelines, which are based on low-quality evidence and expert opinion, restrict screening to a very specific patient population: ie, those with long-standing gastroesophageal reflux disease ( 5 years) and those with frequent reflux symptoms (weekly or more) with 2 or more risk factors for Barrett esophagus or esophageal adenocarcinoma. […] Patients diagnosed with Barrett esophagus without dysplasia should undergo endoscopy every 3 to 5 years. […] However, nearly 90% of cases of esophageal adenocarcinoma are diagnosed in patients not known to have Barrett esophagus. This shows that the current screening guidelines continue to miss a large number of patients at risk. […] For small esophageal adenocarcinoma lesions (ie, 1.5 cm), multiple studies have shown endoscopic mucosal resection to be an effective strategy with good long-term results. For larger lesions or suspected deeper invasion or squamous cell carcinoma, a multidisciplinary approach is warranted.

• #45 Prediction of Barrett’s Esophagus Among Men

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3903120/

  Barretts esophagus was found in 70 (8.5%) of 822 CRC screenees. […] The prevalence of Barretts esophagus was substantial in our population of older overweight men. […] A model based on GERD, age, abdominal obesity, and cigarette use more accurately classified the presence of Barretts esophagus than did a model based on GERD alone. […] We created a prediction tool, which had a NRI index of ~20% for classifying the probability of Barretts esophagus compared with a model based on GERD frequency and duration alone. […] Our novel prediction tool more accurately classifies the presence of Barretts esophagus than does a model based on GERD symptom frequency and duration alone.

• #46 Prediction of Barrett’s Esophagus Among Men

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3903120/

  Barretts esophagus was found in 70 (8.5%) of 822 CRC screenees. […] The prevalence of Barretts esophagus was substantial in our population of older overweight men. […] A model based on GERD, age, abdominal obesity, and cigarette use more accurately classified the presence of Barretts esophagus than did a model based on GERD alone. […] We created a prediction tool, which had a NRI index of ~20% for classifying the probability of Barretts esophagus compared with a model based on GERD frequency and duration alone. […] Our novel prediction tool more accurately classifies the presence of Barretts esophagus than does a model based on GERD symptom frequency and duration alone.

• #47 Predictors of Progression in Barrett’s Esophagus: Current Knowledge and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3408387/

  Barretts esophagus is the strongest risk for esophageal adenocarcinoma (EAC), a malignancy with persistently poor long-term outcomes. […] Identification of factors predicting progression to EAC would help in focusing surveillance, chemoprevention or ablation at those deemed to be at highest risk of progression. […] Clinical and demographic factors (age, male gender, length of BE segment) are associated with modestly increased odds of progression to EAC in some studies. […] Biomarkers such as aneuploidy and p53 loss of heterozygosity have been associated with increased risk of progression to high-grade dysplasia and / or EAC in single center prospective cohort studies. […] Development of a comprehensive BE risk progression score comprised of both clinical and biomarker variables should be the ultimate goal and can be achieved by multicenter prospective collaborative efforts.

• #48 Predictors of Progression in Barrett’s Esophagus: Current Knowledge and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3408387/

  Though challenging, creation of such a score has the potential to improve outcomes and make the management of patients with BE more cost effective. […] The long-term survival of patients with EAC who present with symptoms remains dismal. […] This evidence from retrospective studies found that patients diagnosed with EAC in BE surveillance programs may have better survival than those diagnosed after the onset of symptoms has led to recommendations for the endoscopic surveillance of patients diagnosed with BE to detect progression to dysplasia and / or EAC. […] The potentially large number of patients with BE, which makes the estimate of subjects requiring surveillance run into millions in the United States, is one of many barriers to efficient and effective surveillance. […] Despite multiple limitations, the grade of dysplasia remains the most widely used tool to assess the risk of progression in BE.

• #49 Predictors of Progression in Barrett’s Esophagus: Current Knowledge and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3408387/

  Barretts esophagus is the strongest risk for esophageal adenocarcinoma (EAC), a malignancy with persistently poor long-term outcomes. […] Identification of factors predicting progression to EAC would help in focusing surveillance, chemoprevention or ablation at those deemed to be at highest risk of progression. […] Clinical and demographic factors (age, male gender, length of BE segment) are associated with modestly increased odds of progression to EAC in some studies. […] Biomarkers such as aneuploidy and p53 loss of heterozygosity have been associated with increased risk of progression to high-grade dysplasia and / or EAC in single center prospective cohort studies. […] Development of a comprehensive BE risk progression score comprised of both clinical and biomarker variables should be the ultimate goal and can be achieved by multicenter prospective collaborative efforts.

• #50 Predictors of Progression in Barrett’s Esophagus: Current Knowledge and Future Directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3408387/

  However, surveillance of all patients with BE remains an expensive and not a cost-effective proposition. […] Assessment of the current knowledge gaps would be of crucial importance in devising a future road map for the development of a practical, cost-effective and widely applicable tool for the risk stratification of patients with BE. […] The grade of dysplasia continues to be the bedrock of risk stratification in patients with BE. […] The currently accepted paradigm attempts to correlate the risk of progression to the grade of dysplasia based on circumstantial evidence that progression occurs in an orderly fashion from no dysplasia to LGD to HGD followed by EAC. […] The reported rate of progression to EAC in patients with LGD has varied from 0.61.2% per year. […] A recent meta-analysis reported that the rate of progression to EAC in LGD was 16.98/1,000 person-years compared with 5.98/1,000 person-years in subjects with no dysplasia, but there was significant heterogeneity between the studies.

• #51 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Consequently, both the American College of Gastroenterology and the American Gastroenterological Association strongly recommend that all potential dysplasia cases be confirmed by at least one experienced GI pathologist before embarking on a management plan. […] Overall, these results suggest that additional or alternative biomarker(s) may be useful to better risk stratify BE patients. […] The objective of TissueCypher is to evaluate samples from BE patients diagnosed as negative for dysplasia, IND, or LGD on routine histologic evaluation to identify those patients most likely to progress to HGD/EAC so that intensified screening or ablation can be offered to them. […] The biggest appeal of ML assessment is that it allows a direct correlation with morphology and provides an objective quantitative measure of the presence and extent of molecular alterations associated with development of dysplasia and EAC, eliminating human interobserver variability.

• #52 The Aberrant Expression of Biomarkers and Risk Prediction for Neoplastic Changes in Barrett’s Esophagus–Dysplasia

  https://www.mdpi.com/2072-6694/16/13/2386

  The aberrant expressions of p53 and p16 in BE-indefinite dysplasia (IND) progressor cohorts predicted the risk of progression. […] Aberrant p16 expression is significantly associated with LGD, HGD, and EAC histology with 10.8 RR, 90% sensitivity, and 87% specificity. […] The overexpression of p53 was identified in all categories of BE-associated dysplasia but the degree of aberrant expression increased with the progression of dysplasia. […] Overall, aberrant p53 expression seems to serve as a marker for the likelihood of progression to HGD/EAC. […] The findings in our study support those of previous studies. […] The aberrant expression of one or a combination of useful biomarkers with high sensitivity and specificity, such as cyclin D1, MCM2, p16, beta-catenin, Ki-67, and p53, appears to be suitable for use in a routine test in a clinical laboratory. […] The British Society of Gastroenterology recommends assessing TP53 using IHC to solve the issue of equivocal histologic diagnoses of dysplasia, reflexively adding this to routine practice.

• #53 Esophageal adenocarcinoma: A dire need for early detection and treatment | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/5/269

  Current guidelines, which are based on low-quality evidence and expert opinion, restrict screening to a very specific patient population: ie, those with long-standing gastroesophageal reflux disease ( 5 years) and those with frequent reflux symptoms (weekly or more) with 2 or more risk factors for Barrett esophagus or esophageal adenocarcinoma. […] Patients diagnosed with Barrett esophagus without dysplasia should undergo endoscopy every 3 to 5 years. […] However, nearly 90% of cases of esophageal adenocarcinoma are diagnosed in patients not known to have Barrett esophagus. This shows that the current screening guidelines continue to miss a large number of patients at risk. […] For small esophageal adenocarcinoma lesions (ie, 1.5 cm), multiple studies have shown endoscopic mucosal resection to be an effective strategy with good long-term results. For larger lesions or suspected deeper invasion or squamous cell carcinoma, a multidisciplinary approach is warranted.

• #54 Esophageal adenocarcinoma: A dire need for early detection and treatment | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/5/269

  Current guidelines, which are based on low-quality evidence and expert opinion, restrict screening to a very specific patient population: ie, those with long-standing gastroesophageal reflux disease ( 5 years) and those with frequent reflux symptoms (weekly or more) with 2 or more risk factors for Barrett esophagus or esophageal adenocarcinoma. […] Patients diagnosed with Barrett esophagus without dysplasia should undergo endoscopy every 3 to 5 years. […] However, nearly 90% of cases of esophageal adenocarcinoma are diagnosed in patients not known to have Barrett esophagus. This shows that the current screening guidelines continue to miss a large number of patients at risk. […] For small esophageal adenocarcinoma lesions (ie, 1.5 cm), multiple studies have shown endoscopic mucosal resection to be an effective strategy with good long-term results. For larger lesions or suspected deeper invasion or squamous cell carcinoma, a multidisciplinary approach is warranted.

• #55 Understanding Barrett’s Esophagus Diagnosis and Cancer Risk

  https://castlebiosciences.com/patient-information/gastroenterology/barretts-esophagus/overview

  Detecting and treating dysplastic Barretts esophagus is an extremely effective way to prevent esophageal adenocarcinoma. However, only treating patients who present with dysplastic Barretts esophagus can result in missing patients who progress to cancer rapidly. In fact, 50% of Barretts esophagus patients who develop cancer were initially treated as if they were low risk because no dysplasia was detected at diagnosis. […] TissueCypher is an artificial intelligence-driven, precision medicine test to predict the risk of progression from Barretts esophagus to cancer, which can identify patients that show no signs of dysplasia but are at high risk of progressing to cancer in the future.

• #56 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Barretts esophagus (BE) is a major risk factor for the development of esophageal adenocarcinoma (EAC). […] The desire for more accurate diagnosis and better risk stratification has prompted the investigation and development of potential biomarkers that might assist pathologists and clinicians in the management of BE patients, allowing more aggressive endoscopic surveillance and treatment options to be targeted to high-risk individuals, while avoiding frequent surveillance or unnecessary interventions in those at lower risk. […] The detection of HGD usually prompts endoscopic therapy, generally in the form of radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR), due to its more frequent association with EAC compared with LGD. […] However, a significant number of BE patients with dysplasia (~20%) are resistant to endoscopic therapy, and recurrences or progression to EAC during endoscopic therapy are not uncommon.

• #57 Esophageal adenocarcinoma: A dire need for early detection and treatment | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/5/269

  Patients with early esophageal adenocarcinoma and risk of lymph node metastasis are best treated with surgical resection, which allows for lymph node dissection, but many patients over age 65 or those with significant comorbidities may not be candidates for surgery. In these patients, endoscopic resection with adjuvant chemotherapy or radiotherapy can be considered.

• #58 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  In conclusion, as the current surveillance methods based on the histologic diagnosis and classification of dysplasia imperfectly assess the risk of BE patients, especially those with IND or NDBE histology, there is an increasing demand for ancillary tests to aid in the diagnosis/grading of dysplasia and risk stratification of BE patients.

• #59 Diagnostic and predictive biomarkers for Barrett’s esophagus: a narrative review – Di – Digestive Medicine Research

  https://dmr.amegroups.org/article/view/7106/html

  One seminal study confirmed p53 as a clinically pertinent predictor of neoplastic progression of BE, showing the overall OR for intense overexpression of p53 in NDBE, and LGD to be 6.1, and 8.6, respectively. Cyclin A has also been considered as a reliable predictive biomarker for neoplastic progression. Its overall OR for predicting neoplastic progression in BE patients is estimated at 1.9. […] During the malignant transformation of BE, microRNA expression appeared to be up-regulated or down-regulated. The up-regulation of miRNA expression is mainly concentrated in microRNA-205, 203, 133-a, 21, 25, and 223, while down-regulation occurs mainly in microRNA-375. These markers, together with microRNA 100, 145, 148, 149, 199a-5p, 29c-3p, 27b, 126, and 143 have been proposed as potentially useful prognostic biomarkers. In other studies, higher expression of microRNA-192, 194, 196a, and 196b are observed in BE patients with progression to EAC than those who do not progress to EAC. […] The ultimate goal is for these biomarkers to serve as important tools for clinicians to make an accurate diagnosis of BE, early diagnosis and eradication of BE-related neoplasia, and risk stratify the risk lesions so that they can benefit from intensive surveillance, and pre-emptive treatment.

• #60 Barrett’s Esophagus: New Tool Predicts the Risk of Cancer

  https://www.linkedin.com/pulse/barretts-esophagus-new-tool-predicts-risk-cancer-pat-salber-md-mba

  Providing risk information from TissueCypher can make a big difference. […] This will help identify the right patients for ablation therapy, prevent cancer, save lives, and eliminate unnecessary cost. […] Cernostics TissueCypher Assay for Barrett’s Esophagus is a technologic advance over traditional tissue biopsy.

• #61 Diagnostic and predictive biomarkers for Barrett’s esophagus: a narrative review – Di – Digestive Medicine Research

  https://dmr.amegroups.org/article/view/7106/html

  One seminal study confirmed p53 as a clinically pertinent predictor of neoplastic progression of BE, showing the overall OR for intense overexpression of p53 in NDBE, and LGD to be 6.1, and 8.6, respectively. Cyclin A has also been considered as a reliable predictive biomarker for neoplastic progression. Its overall OR for predicting neoplastic progression in BE patients is estimated at 1.9. […] During the malignant transformation of BE, microRNA expression appeared to be up-regulated or down-regulated. The up-regulation of miRNA expression is mainly concentrated in microRNA-205, 203, 133-a, 21, 25, and 223, while down-regulation occurs mainly in microRNA-375. These markers, together with microRNA 100, 145, 148, 149, 199a-5p, 29c-3p, 27b, 126, and 143 have been proposed as potentially useful prognostic biomarkers. In other studies, higher expression of microRNA-192, 194, 196a, and 196b are observed in BE patients with progression to EAC than those who do not progress to EAC. […] The ultimate goal is for these biomarkers to serve as important tools for clinicians to make an accurate diagnosis of BE, early diagnosis and eradication of BE-related neoplasia, and risk stratify the risk lesions so that they can benefit from intensive surveillance, and pre-emptive treatment.

• #62 Barrett’s Esophagus: Symptoms, Causes, Treatments & Medications

  https://my.clevelandclinic.org/health/diseases/14432-barretts-esophagus

  Because of the small chance it might progress to esophageal cancer, healthcare providers like to keep an eye on Barretts esophagus. But the risk is only about half a percent per year. […] If you remove the affected tissue and stop whatever was injuring your esophagus, Barretts esophagus may be cured. But it can return. […] In general, your prognosis (outlook) is better the sooner you seek treatment. You can prevent and even remove cancerous changes if you catch them early enough.

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