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Dysplasia

Dysplasia (latin for 'bad form') is an abnormality in the appearance of cells indicative of an early step towards transformation into a neoplasia. It is therefore a pre-neoplastic or pre-cancerous change. This abnormal growth is restricted to the epithelial layer, not invading into the deeper tissue. Though dysplasia may regress spontaneously, persistent lesions must be removed, either with surgery, chemical burning, heat burning, burning with laser, or freezing (cryotherapy). more...

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The best know form of dysplasia is the precursor lesions to cervical cancer, called cervical intraepithelial neoplasia (CIN). This lesion is caused by an infection with the human papilloma virus (HPV). Dysplasia of the cervix is almost always unsuspected by the woman. It is usually discovered by a screening test, the pap smear. The purpose of this test is to diagnose the disease early, while it is still in the dysplasia phase and easy to cure.

Dysplasia vs carcinoma in situ vs invasive carcinoma

These terms are related since they represent the three steps of the progression towards cancer:

Dysplasia is the earliest form of pre-cancerous lesion recognizable in a biopsy by a pathologist. Dysplasia can be low grade or high grade (see CIS below). The risk of low grade dysplasia transforming into high grade dysplasia and, eventually, cancer is low. Treatment is usually easy.
Carcinoma in situ is synonymous with high grade dysplasia in most organs. The risk of transforming into cancer is high. Treatment is still usually easy.
Invasive carcinoma, commonly called cancer, is the final step in this sequence. It is a disease who, when left untreated, will invade the host (hence its name) and will probably kill him. It can be often, but not always, be treated successfully.

Metaplasia is a situation where cells have changed from their original mature differentiated type into another mature differentiated cell type as an adaptive response to exposure to chronic irritation, or to a pathogen or carcinogen. It also occurs where one normal cell type changes into another normal cell type as in the cervix where squamous epithelium on the exo-cervix changes to normal columnar epithelium in the endo-cervix. This area is also known as the transformation zone and is the location of many dyplastic lesions thus the sampling of this area during a pap test is critical. Metaplasia is distinct from dysplasia because in a dysplastic cell these changes have become encoded into the genome and so are heritable or passed on to daughter cells during cell replication.

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Comparison of autofluorescence bronchoscopy with video white light and high magnification video bronchoscopy for the detection of bronchial dysplasia or
From CHEST, 10/1/05 by Johann C. Brandes

PURPOSE: Autofluorescence (AF) Bronchoscopy has been reported to have superior sensitivity in the detection of dysplastic and malignant bronchial epithelium when compared to fiberoptic white light bronchoscopy. This study is designed to compare the quality of fiberoptic autofluorescence bronchoscopy with latest generation white light videobronchoscopy (VB) and high magnification bronchoscopy (HMB).

METHODS: 41 mucosal biopsies were taken from 8 patients with either prior history of lung cancer (#5) or suspected lung cancer (# 3) who underwent diagnostic bronchoscopy. Bronchoscopes used were a Karl-Storz D-light autofluorescence system and the Olympus 160 series videobronchoscope. A prototype Olympus XBF-D160HM (High Magnification) broncosope was used in a subset of patients. Bronchoscopic findings were interpreted by two pulmonologists (JB and RY) and graded on a scale of I (normal), II (inflammation), Iii (dysplasia) and IV (suggestive of invasive malignancy). Airway biopsies were taken of all grade III and IV lesions, plus major lobar bronchi.

RESULTS: Sensitivity and specificity of the respective bronchoscopic methods were as follows: White light VB including high magnification: sensitivity 30%, specificity 32%, fiberoptic white light: sensitivity: 30%, specificity: 45%, AF: sensitivity:. 50%, specificity 37%. False positive results for AF bronchosopy were frequently observed in areas of surgical margins, inflammation and biopsy sites. Lesions missed by AF bronchoscopy were four lesions of squamous metaplasia and one low grade dysplasia. No high grade lesion was missed.

CONCLUSION: Bronchoscopy with AF imaging has superior sensitivity and equal specificity when compared with the newest video white light bronchoscopes and conventional fiberoptic white light bronchoscopy. Video bronchoscopes do not offer additional sensitivity over fiberoptic white light bronchoscopes.

CLINICAL IMPLICATIONS: When diagnostic bronchoscopy with AF was initially compared with fiberoptic white light bronchoscopy, it was suggested that the observed benefit from AF will not persist when compared with the advanced white light video bronchoscopy. Our data confirm a trend towards superiority of AF bronchoscopy over video white light bronchoscopy with or without high magnfication features. Further studies with larger numbers are needed to confirm this trend.

DISCLOSURE: Johann Brandes, None.

Johann C. Brandes MD * Loretta Colvin RN Rex Yung MD Johns Hopkins University School of Medicine, Baltimore, MD

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