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Poor interobserver agreement between pathologists on the grade of dysplasia (particularly LGD) Variable natural predictive value of dysplasia, with variable progression rates reported for different cohorts for the same grade of dysplasia Patchy and subtle distribution of advanced dysplasia, so that sampling error is likely during surveillance Despite these limitations, the grade of dysplasia (no dysplasia, LGD, or HGD) is the primary clinical risk-stratification tool (Figure 2.5)