What is the definition of "indefinite for dysplasia" in Barrett's mucosa?

W.V. Bogomoletz (Reims)

Dysplasia occurs in patients with Barrett's esophagus (BE), either extensively or focally and with or without associated adenocarcinoma. Dysplasia is considered as a precursor of adenocarcinoma arising in BE [1,2]. Moreover, dysplasia in BE has been defined as an unequivocal neoplastic alteration [3].

In recent years, dysplasia in BE has been graded by many experts according to a system similar to that used for grading dysplasia in inflammatory bowel disease [4]. This system comprises three major categories: negative for dysplasia (including inflammatory and regenerative changes), indefinite for dysplasia and positive for dysplasia, the latter being subdivided into a low grade and a high grade [4].

The indefinite for dysplasia category includes all mucosal changes in which it is not possible to decide whether these changes are inflammatory or regenerative in nature, or constitute genuine neoplastic lesions. The inference is that a diagnosis of indefinite for dysplasia should be restricted to cases in which the changes are too marked for negative, but not sufficient for dysplasia. At the other end of the scale, however, it may be difficult to differentiate between the indefinite for dysplasia category and low-grade dysplasia [5],

In practical terms, a diagnosis of indefinite for dysplasia is an unsatisfactory situation. The pathologist should certainly ask for further biopsies and the endoscopist should be encouraged to take them.

References

1. Spechier SJ, Goyal RK, Barrett's esophagus. N Engl J Med 1986:315:362-371.

2. Potet F, Duchatelle V. Barrett's oesophagus. In: Williams GT (ed) Gastrointestinal Pathology. Current Topics in Pathology No.81. Berlin: Springer Verlag, 1990:43-60.

3. Riddell RH. Dysplasia and regression in Barrett's epithelium In: Spechier SJ, Goyal RK (eds) Barrett's Esophagus. New York: Elsevier, 1985:143-152.

4. Schmidt HG, Riddell RH, Walther B, Skinner DB, Riemann JF. Dysplasia in Barrett's esophagus. J Cancer Res Clin Oncol 1985:110:145-152.

5. Reid BJ, Haggitt RC, Rubin CE et al. Observer variation in the diagnosis of dysplasia in Barrett's esophagus. Hum Pathol 1988:19:166-178.