低级别的上皮增生(dysplasia)与Barrett食管的进展风险增加有关。然而，对低级别上皮增生的诊断受到了显著的观察者间变异的限制。多项研究表明，一种客观的组织系统病理学测试(TissueCypher Barrett's Esophagus Assay, TSP-9)可以有效预测Barrett食管患者的肿瘤进展。本研究旨在比较TSP-9测试与普通病理学和专家病理学的风险分层能力。 在一项随机对照试验的筛查队列中，对社区低级别上皮增生的Barrett食管患者进行了一项盲目队列研究。来自第一次内窥镜检查的低级别上皮增生组织经过TSP-9测试评估，并按照标准流程由来自五个国家的30名病理学家进行独立评估。比较了测试结果的准确性和诊断对高级别上皮增生(high-grade dysplasia, HGD)和食管腺癌(esophageal adenocarcinoma, EAC)的预测能力。 共研究了154例Barrett食管患者(122例男性)，平均年龄为60.9+/-9.8岁。在5年内，24名患者出现了HGD/EAC进展(中位进展时间为1.7年)，而130名患者在5年内未出现HGD/EAC进展(中位7.8年随访时间)。TSP-9测试在检测进展患者方面表现出较高的敏感性(71% vs. 平均63%，30名病理学家范围为33-88%)，高于病理学评估(P=0.01186)。 TSP-9测试在风险分层Barrett食管低级别上皮增生患者方面优于病理学家的表现。该测试指导下的管理可为高进展风险患者提供有效的治疗干预，改善健康结果，并减少低风险患者的不必要干预。 版权所有 ©2023 AGA Institute. 由Elsevier Inc.出版，保留所有权利。

Low-grade dysplasia (LGD) is associated with an increased risk of progression in Barrett's esophagus (BE). However, the diagnosis of LGD is limited by substantial interobserver variability. Multiple studies have shown that an objective tissue systems pathology test (TissueCypher Barrett's Esophagus Assay, TSP-9), can effectively predict neoplastic progression in patients with BE. This study aimed to compare the risk stratification performance of the TSP-9 test versus benchmarks of generalist and expert pathology.A blinded cohort study was conducted in the screening cohort of a randomized controlled trial of BE patients with community-based LGD. Biopsies from the first endoscopy with LGD were assessed by the TSP-9 test and independently reviewed by 30 pathologists from five countries per standard practice. The accuracy of the test and the diagnoses in predicting to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) were compared.154 BE patients (122 men), mean age 60.9+/-9.8 years were studied. Twenty-four patients progressed to HGD/EAC within 5 years (median time of 1.7 years) and 130 did not progress to HGD/EAC within 5 years (median 7.8 years follow-up). The TSP-9 test demonstrated higher sensitivity (71% vs. mean 63%, range 33-88% across 30 pathologists), than the pathology review in detecting patients who progressed (P=0.01186).The TSP-9 test outperformed the pathologists in risk-stratifying BE patients with LGD. Care guided by the test can provide an effective solution to variable pathology review of LGD, improving health outcomes by upstaging care to therapeutic intervention for patients at high risk for progression, while reducing unnecessary interventions in low-risk patients.Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.