Understanding the histological report of Barrett's esophagus (with or without dysplasia)

Article by Master, Doctor Nguyen Van Khanh - Pathologist - Laboratory Department - Vinmec Times City International Hospital

When the esophagus is biopsied endoscopically, the specimen is studied under a microscope by a pathologist. The pathologist will send the results to your doctor. The information in these results will help your doctor plan your treatment more specifically. The following topics will help you understand more about the medical terminology used in the anatomy of Barrett's esophagus.

The esophagus is a tube-shaped organ that connects the mouth and stomach. The place where the esophagus meets the stomach is called the gastroesophageal junction.
What does this mean if the results refer to the term Barrette, goblet cell, or intestinal metaplasia? The inner lining of the esophagus is called the mucosa. It is called the squamous mucosa, when the top layer is made up of squamous cells. Squamous cells are flat cells that look like fish scales when viewed under a microscope. Most of the esophagus is lined with squamous mucosa.
Normal goblet cells are located in the intestine, not in the esophagus. When goblet cells are found where they are not normally present, such as in the esophagus, it is called intestinal metaplasia. Intestinal metaplasia can be present anywhere that normal squamous mucosa is present. When intestinal metaplasia is found in the squamous lining of the esophagus, it is called Barrett's esophagus.

Barrett's esophagus occurs when there is chronic reflux of stomach contents into the esophagus, damaging the lining inside the esophagus. This process usually takes many years. (The backflow of stomach contents into the esophagus is called gastroesophageal reflux disease. It can cause heartburn.)
To the question, does Barrett's esophagus increase the risk of cancer? then the answer is yes. Patients with Barrett's esophagus have an increased risk of esophageal cancer. However, most patients with Barrett's esophagus do not progress to cancer.
What does this mean if the pathology report mentions Barrett's esophagus and dysplasia? Sometimes the cells of Barrett's esophagus become more abnormal. This is called dysplasia. Dysplasia is precancerous, and although the cells are abnormal, they are unlikely to metastasize to other sites. This condition is treatable. Dysplasia is usually divided into two grades based on how abnormal the cells look under the microscope: low grade and high grade.
What does this mean if my pathology is negative for dysplasia? This means you don't have any precancerous (premalignant) changes on your biopsy.
If my pathology says there are unspecified changes for dysplasia in Barrett's esophagus, what does that mean? It means that your biopsy shows that Barrett's esophagus contains some abnormal cells, but it's not abnormal enough to be considered dysplasia. Usually, people with such changes have a lot of reflux, which irritates the cells in the esophagus so that the cells look abnormal under the microscope.
If my pathology report says there are unspecified changes for dysplasia in Barrett's esophagus, will I have cancer? People with Barrett's esophagus who have unspecified changes to dysplasia have a small risk of esophageal cancer, but most do not go on to develop this cancer.

If you have these signs, your doctor may recommend another colonoscopy and biopsy within 3 to 6 months, after increasing your reflux medication. Follow-up plans are subject to change, so you should discuss this with your treating physician to determine what is best for you.
If my results show low grade dysplasia in Barrett's esophagus, what does that mean? Low-grade dysplasia is that some cells look like cancer cells, but unlike cancer, they are not capable of spreading to other parts of the body. This is a very early form of esophageal cancer.
If my results show low-grade dysplasia in Barrett's esophagus, will I get cancer? Patients with low-grade dysplasia in Barrett's esophagus have an increased risk of esophageal cancer, but most will not develop this cancer.

Your doctor may want a repeat endoscopy to further biopsy your esophagus to make sure you don't have anything worse. Alternatively, your doctor may ask that your sample be sent to another specialist for further consultation.
Your doctor will recommend some treatment to remove some abnormal areas (usually both Barrett and dysplastic areas).
If my pathology shows high-grade dysplasia in Barrett's esophagus, what does that mean? High-grade dysplasia means that some cells in the Barrett's esophagus look very similar to abnormal cells under a microscope. This is a more advanced esophageal pre-cancer than low-grade dysplasia.
If my pathology shows high-grade dysplasia in Barrett's esophagus, will I get cancer? People with high-grade dysplasia in Barrett's esophagus have an increased risk of esophageal cancer.

Your doctor may want to repeat the endoscopy and biopsy more samples to make sure you don't have cancer. Your doctor may also ask that your biopsy samples be sent to another pathologist for a second opinion.
Because high-grade dysplasia is strongly associated with cancer, your doctor will recommend some treatment for the area of ​​dysplasia. Different patients may be treated differently, so discuss your treatment plan with your doctor. Most treatment can be done without cutting your esophagus.
What does this mean if my results also have inflammation? A number of things can irritate the esophagus and lead to inflammation, including acid from the stomach, trauma from medication, and infection. Your doctor will work with you to find the cause and treat it. This can prevent more serious problems.

Source: American Cancer Society.