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. 2023 Sep;83(3):406-413.
doi: 10.1111/his.14959. Epub 2023 May 18.

Degree of crypt atypia correlates with progression to high-grade dysplasia/adenocarcinoma in non-dysplastic Barrett's oesophagus

Robert Odze  1 , Nicola Frei  2 , Amir M Khoshiwal  2 , Lucas C Duits  2 , Jacques Bergman  2 , Matthew D Stachler  3
Affiliations

Degree of crypt atypia correlates with progression to high-grade dysplasia/adenocarcinoma in non-dysplastic Barrett's oesophagus

Robert Odze et al. Histopathology. 2023 Sep.

Abstract

Aims: Patients with non-dysplastic Barrett's oesophagus (BE) often show a wide range of 'atypical' histological features in the bases of the crypts. However, the significance of crypt atypia has never been evaluated, despite prior studies showing the presence of DNA content and other molecular abnormalities in this epithelium. The aim of this study was to evaluate whether the degree of crypt atypia in BE patients without dysplasia correlates with progression to high-grade dysplasia/adenocarcinoma (HGD/EAC).

Methods and results: Baseline biopsies from 114 BE patients without dysplasia, 57 who progressed to HGD/EAC (progressors) and 57 who did not progress (non-progressors), were included in the study. Biopsies were evaluated for the degree of basal crypt atypia on a three-point scale according to discrete histological criteria. In non-progressors, 64.9, 31.6 and 3.5% of biopsies had a crypt atypia score of 1, 2 and 3, respectively, with a mean score of 1.39 ± 0.56. The percentage of biopsies with an atypia score of 2 or 3 increased in progressors [42.1, 42.1 and 15.8% of biopsies scored 1, 2 or 3, respectively, with a mean score of 1.74 ± 0.72 (P = 0.004)]. The odds ratio of grade 3 crypt atypia for progression to HGD/EAC was 5.2 (95% confidence interval = 1.1-25.0, P = 0.04) and the findings did not change significantly when the data were analysed according to progression to either HGD or EAC.

Conclusions: This study shows that non-dysplastic crypts in BE are biologically abnormal, suggesting that neoplastic progression begins prior to the onset of dysplasia. The degree of crypt atypia in BE patients without dysplasia correlates with progression.

Keywords: Barrett's oesophagus; crypt atypia; dysplasia.

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Conflict of interest statement

Disclosure statement: The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Representive histologic images of grade 1, grade 2, and grade 3 atypia scores. Grading was performed blinded to outcome status according to the criteria outlined in Table 1.
Figure 1.
Figure 1.
Representive histologic images of grade 1, grade 2, and grade 3 atypia scores. Grading was performed blinded to outcome status according to the criteria outlined in Table 1.
See this image and copyright information in PMC

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