Castle Biosciences' TissueCypher Alters Surveillance in 55% of Barrett's Patients
CSTL•At DDW 2026, Mayo Clinic studies showed Castle Biosciences' TissueCypher testing led physicians to modify surveillance intervals in 55% of Barrett's esophagus patients and align intervals with molecular risk in 79% of cases. Concordance with the PIB model was minimal (κ=0.04), with 84% classified low risk versus 38% by PIB.
1. Improved Surveillance Recommendations
In a multicenter cohort, physicians modified surveillance intervals in 55% of Barrett's esophagus patients after TissueCypher testing and aligned recommendations with molecular risk classification in 79% of cases. Among intermediate/high-risk patients, 93% received shorter surveillance intervals, and 92% of non-dysplastic cases were escalated compared with traditional guidelines.
2. Minimal Concordance with Clinical Model
When compared with the Progression in Barrett's Esophagus (PIB) model, TissueCypher classified 84% of patients as low risk versus 38% by PIB, yielding a kappa concordance of 0.04. Most discordance arose from patients deemed intermediate/high risk by PIB but low risk by molecular analysis, highlighting gaps in traditional histopathological assessment.
3. Impact on Patient Stratification and Care
The data suggest molecular stratification can drive risk-aligned management, enabling escalation of care through endoscopic eradication therapy or shortened surveillance for higher-risk patients and de-escalation for lower-risk individuals. Such personalized approaches may optimize healthcare resources and improve patient outcomes by targeting interventions more effectively.
4. TissueCypher Test Technology and Validation
TissueCypher is an AI-driven spatialomics test that predicts a patient’s five-year risk of progression to high-grade dysplasia or esophageal adenocarcinoma based on molecular signatures in standard endoscopic biopsy samples. Validated in biopsies from over 8,000 patients and supported by 17 peer-reviewed studies, the test integrates into routine practice without additional procedures.
