New Data Show TissueCypher Test Identifies Elevated Progression Risk in Barrett's Esophagus Cases

Castle Biosciences presented findings from three new studies evaluating its TissueCypher Barrett's Esophagus (BE) test at the American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting. BE is a precancerous condition associated with an increased risk of esophageal adenocarcinoma (EAC).

The TissueCypher test analyzes protein biomarkers and tissue architecture from routine endoscopic biopsy samples to provide an individualized five-year probability of progression to high-grade dysplasia (HGD) or EAC. The newly presented data suggest the test can offer additional risk information that complements standard histopathology, aiding clinicians in patient management decisions.

One study, a multi-center cohort analysis, compared the risk stratification provided by TissueCypher with established clinicopathologic risk stratification approaches. The findings indicated low agreement between the methods, with TissueCypher classifying 17% of patients as intermediate or high risk, compared to 69% by the traditional approach. Management recommendations were significantly altered for many patients following TissueCypher testing.

A separate case report highlighted a patient with non-dysplastic BE, typically considered low-risk. However, the TissueCypher test identified an elevated risk, leading to earlier endoscopic re-evaluation and the discovery of previously missed HGD. These results indicate that TissueCypher may help identify patients at higher risk more precisely, enabling more individualized surveillance and treatment plans.