S4399 High-Risk Tissue Systems Pathology Test (TSP-9) Results Enable Risk-Aligned Management of Patients With Presumed Clinically Low-Risk Non-Dysplastic Barrett’s Esophagus

Introduction: Current gastroenterology society guidelines recommend endoscopic surveillance for Non-dysplastic Barrett’s esophagus (NDBE) at 3–5-year intervals. However, a subset of patients with NDBE can progress to high-grade dysplasia or esophageal adenocarcinoma (EAC) within this timeframe; failure to identify these high-risk patients presents a challenge for reducing the incidence and mortality of EAC. The tissue systems pathology test (TissueCypher™, TSP-9) has been validated to predict a patient’s individualized risk of progression to high-grade dysplasia/EAC within 5 years. These cases demonstrate how TSP-9 results guide personalized care for patients with NDBE. Case Description/Methods: Patient A is a 54-year-old White man with a 12-year history of stable Barrett’s esophagus described as a C3M4, NDBE lesion. At his last surveillance endoscopy, biopsies were sent for TSP-9 testing and revealed a high-risk score with a 5-year probability of progression of 43%. This led to a risk-aligned recommendation for endoscopic eradication therapy (EET). At subsequent referral to an interventional endoscopist for EET, repeat biopsies at 6 months interval from TSP-9 testing demonstrated progression to low grade dysplasia as confirmed by two GI pathologists. Although the current plan for EET was temporarily interrupted due to other medical co-morbidities, the patient is slated for eventual EET rather than routine surveillance biopsies only. Patient B is a 71-year-old White woman with a short segment (C0M1), NDBE lesion. TSP-9 testing revealed a high-risk score corresponding to a 5-year probability of progression of 45%. Risk-benefit discussions guided by the TSP-9 test led the patient to elect short-interval (1-yr) surveillance in lieu of EET. At 1-year follow, there was no change in histological grade of Barrett’s esophagus, but the 2-year follow-up demonstrated progression to low grade dysplasia as confirmed by 3 GI pathologists. This progression preceded the 3–5-year surveillance interval recommended in current guidelines. Hence, the patient was reconsidered for EET discussion and decided to proceed with EET. Discussion: These cases demonstrate that TSP-9 can provide individualized risk stratification for patients with NDBE, predicting progression of dysplasia earlier than guideline recommended surveillance interval time. The high-risk TSP-9 results enabled risk-aligned decision making for both patients that guided the decision for EET to prevent progression at an earlier, more treatable stage.