Original ArticlesRefined Criteria for Separating Low-grade Dysplasia and Nondysplastic Barrett Esophagus Reduce Equivocal Diagnoses and Improve Prediction of Patient Outcome A 10-Year ReviewWaters, Kevin M. MD, PhD*; Salimian, Kevan J. MD, PhD†; Voltaggio, Lysandra MD†; Montgomery, Elizabeth A. MD†Author Information *Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA †Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Kevin M. Waters, MD, PhD, Pacific Theatres Building, 116 N., Robertson Blvd. Suite 500, Los Angeles, CA 90048 (e-mail: firstname.lastname@example.org). The American Journal of Surgical Pathology: December 2018 - Volume 42 - Issue 12 - p 1723-1729 doi: 10.1097/PAS.0000000000001162 Buy Metrics Abstract The indefinite for dysplasia (IFD) category in Barrett esophagus (BE) is used for biopsies that are neither unequivocally dysplastic nor negative for dysplasia (NFD). In 2012, we refined our criteria so that BE with maintained cell polarity and surface gastric-type mucin vacuoles is considered NFD even with mild to moderate nuclear enlargement. A total of 1549 cases from 1130 patients with BE biopsies were identified from 2007 to 2016. Follow-up on patients with IFD biopsies was obtained to learn if the new thresholds better defined risk of progression. The earlier cases (2007-2011) were less likely than later cases (2012-2016) to be NFD (84.0% vs. 90.4%) and more likely to be IFD (8.4% vs. 4.3%). The proportions of low-grade dysplasia (3.9% vs. 2.5%, high-grade dysplasia (1.4% vs. 1.3%), and intramucosal carcinoma (2.3% vs. 1.6%) were similar between the earlier and later cases, respectively. Later IFD cases were more frequently dysplastic (3/21, 14.3%) on the next biopsy than earlier cases (1/48, 2.1%). The rate of dysplasia on the next biopsy for NFD cases was not higher in the later cases (6/222, 2.7%) than the earlier cases (16/360, 4.4%). Improved diagnostic criteria reduced the proportion of IFD cases by nearly 50% from 2007 to 2016. This change coincided with a higher proportion of IFD cases having dysplasia on the next biopsy. NFD patients had no increase in dysplasia on the next biopsy providing evidence that dysplastic cases are not missed by the refined criteria. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.