Natural history and significance of esophageal squamous cell dysplasia

Pothen Jacob, Peter J Kahrilas*, Tusar Desai, Denise Hidvegi, Jami Walloch, Hidejiro Yokoo, A. Marion Gurley, J. Donald Ostrow

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Balloon‐mesh cytologic screening for esophageal cancer done in 255 asymptomatic high‐risk United States veterans (age > 40 years, ethanol abuse for > 20 years, and cigarette smoking > 20 pack years} identified 37 patients with squamous cell dysplasia. Of the 37 patients with dysplasia, 28 were re‐evaluated prospectively at 6‐month intervals for up to 36 months by balloon‐mesh cytology, esophagoscopy with vital staining and biopsies, chest radiographs, oropharyngeal examination, and indirect laryngoscopy. During prospective follow‐up evaluation, cytology specimens were repetitively normal in 16 patients (57%), showed inflammatory changes in eight patients (29%), persisted as dysplasia in two patients (7%) (both had endoscopic and histologic evidence of esophagitis), and progressed to carcinoma in two patients (7%) (one esophageal, one laryngeal). Although histologic findings concurred with the resolution of dysplasia, biopsy specimens were characterized by a similar difficulty in distinguishing dysplasia from inflammation. Erroneous histologic diagnoses of carcinoma in situ were made in two patients with reflux esophagitis evident endoscopically and confirmed during the course of a 24‐36 month follow‐up period. The authors conclude that squamous cell dysplasia detected by balloon‐mesh cytology is seldom a precursor of esophageal cancer in the high‐risk U.S. population but, rather, is often related to esophagitis. Thus, balloon‐mesh cytology has limited use as a screening method for the early detection of esophageal cancer in the United States.

Original languageEnglish (US)
Pages (from-to)2731-2739
Number of pages9
Issue number12
StatePublished - Jan 1 1990

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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