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Meta-analysis finds TSP-9 test predicts progression to HGD/EAC in Barrett's esophagusTSP-9 test predicts disease progression in Barrett's esophagus patients with high accuracy

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Key Takeaway
Consider TSP-9 test results as an associative risk marker in Barrett's esophagus, not a proven intervention.

A systematic review and meta-analysis of six clinical validity studies evaluated the predictive performance of the Tissue Systems Pathology (TSP-9) test in 699 patients with Barrett's esophagus. The primary outcome was progression to high-grade dysplasia or esophageal adenocarcinoma (HGD/EAC). The comparator was not reported. The analysis found the TSP-9 test was significantly associated with progression, with an odds ratio of 6.52 (95% CI: 4.40-9.66, P <0.0001) and a hazard ratio of 6.66 (95% CI: 4.59-9.66, P <0.0001). The test demonstrated a sensitivity of 61% (95% CI: 54%-68%) and a specificity of 81% (95% CI: 78%-84%) for predicting progression. The prevalence-adjusted negative predictive value was 97% (95% CI: 96%-98%), while the positive predictive value for a high-risk result was 28% (95% CI: 17%-42%). Safety and tolerability data were not reported. The authors reported minimal to moderate heterogeneity among the included studies. Key limitations, such as the specific study designs of the included trials, potential verification bias, or details on patient follow-up, were not detailed in the provided input. Funding sources and author conflicts of interest were also not reported. The practice relevance is that the TSP-9 test may provide information to help identify patients at higher or lower risk of progression, but this evidence demonstrates an association, not causation, and does not establish that using the test improves clinical outcomes.

Researchers combined data from six clinical validity studies to evaluate the Tissue Systems Pathology (TSP-9) test. This test was used to assess patients diagnosed with Barrett's esophagus, a condition where the lining of the esophagus changes. The goal was to see if the test could accurately identify which patients were at higher risk for developing more serious conditions like high-grade dysplasia or esophageal adenocarcinoma.

The analysis showed that the TSP-9 test performed well at identifying patients who would progress to these conditions. When the test indicated a positive result, the likelihood of progression was significantly higher compared to those with negative results. The study reported high negative predictive value, meaning a negative result was very reliable for ruling out immediate progression risk.

Despite these promising numbers, readers should be cautious about interpreting the results. The test correctly identified a specific percentage of high-risk cases, but many positive results were false alarms. This means a positive test does not guarantee disease will happen, and a negative test does not guarantee safety forever. The study notes that these findings are based on associations, not proof of cause and effect. Clinicians may use this information to decide on surveillance plans, but it is not a standalone diagnostic tool.

What this means for you:
Meta-analysis shows TSP-9 test predicts progression in Barrett's esophagus with high negative predictive value.

Study Details

Study typeMeta analysis
Sample sizen = 699
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
GOALS: A systematic review and meta-analysis of published clinical validity studies was conducted to evaluate the predictive performance of the TSP-9 test. BACKGROUND: Identifying patients with Barrett's esophagus (BE) who will progress to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) is challenging. The tissue systems pathology (TSP-9) test can predict risk of progression to HGD/EAC in BE patients. STUDY: Databases were searched for studies that assessed the clinical validity of TSP-9, and data describing progressors, non-progressors, TSP-9 results, and hazard ratios (HR) with 95% confidence intervals (CIs) were extracted. Odds ratios (OR), sensitivity, specificity, and prevalence-adjusted positive and negative predictive values (PPV adj /NPV adj ) were calculated and used for meta-analysis. RESULTS: Six studies met eligibility criteria, comprising 699 patients. ORs and HRs for TSP-9 had mean common effect size estimates of 6.52 (95% CI: 4.40-9.66, P <0.0001, I2 =33%) and 6.66 (95% CI: 4.59-9.66, P <0.0001, I2 =0%), respectively, for predicting progression to HGD/EAC. Mean common effect size estimates were 61% (95% CI: 54%-68%) for sensitivity, 81% (95% CI: 78%-84%) for specificity, 28% (95% CI: 17%-42%) for PPV adj (high risk), 14% (95% CI: 9%-21%) for PPV adj (high/int risk), and 97% (95% CI: 96%-98%) for NPV adj with minimal inter-study heterogeneity ( I2 =79%, 21%, 0%, 0%, and 0%, respectively). CONCLUSIONS: Effect estimates of TSP-9 performance demonstrate that the test provides risk stratification for BE patients. The TSP-9 test can provide clinically impactful results to enable escalation of care for high-risk patients or to identify low-risk patients who can be safely managed with routine surveillance.
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