Data presented at ACG 2026 show the spatialomics test provides objective risk stratification to guide surveillance and intervention.
New data from three studies show that the TissueCypher Barrett’s Esophagus test provides objective risk assessment beyond standard histopathology to identify patients at elevated risk of progression, according to Castle Biosciences.
The findings, presented at the American College of Gastroenterology 2026 Annual Scientific Meeting in Nashville, Tennessee, evaluate how the precision medicine test informs surveillance and treatment decisions in patients with Barrett’s esophagus. The presentations include a multi-center cohort study and two clinical case reports.
BE is a precancerous condition associated with an increased risk of esophageal adenocarcinoma. Standard endoscopic biopsy evaluation alone does not always reflect an individual patient’s biological risk of progression, creating clinical management challenges. TissueCypher evaluates protein biomarkers and tissue architecture within routine endoscopic pinch biopsy specimens to generate an individualized five-year probability of progression to high-grade dysplasia or esophageal adenocarcinoma.
“Endoscopic biopsy findings do not always tell the whole story when it comes to a patient’s risk of progression,” says Virendra Joshi, MD, board-certified gastroenterologist, associate professor in the division of digestive diseases in the department of medicine at Emory University School of Medicine, and study author, in a release. “The studies being presented at ACG demonstrate how TissueCypher can complement standard pathology by providing objective molecular risk information that helps guide surveillance and treatment decisions for patients with Barrett’s esophagus, particularly when a patient’s molecular risk suggests a different approach than their biopsy diagnosis alone would indicate.”
ACG Study Presentations
The data presented at the meeting evaluate the test’s utility across varying clinical scenarios, including:
- Poster P3056: Evaluated the tissue systems pathology test’s ability to detect missed prevalent dysplasia in a patient with non-dysplastic Barrett’s esophagus who was presumed to be at low clinical risk.
- Poster P5192: Assessed the real-world impact of the test on patient management decisions across a multi-center cohort.
- Poster P5296: Examined how the test facilitated early intervention in a histopathologically complex case of Barrett’s esophagus.
Spatialomics and Risk Stratification
TissueCypher uses an artificial intelligence-derived spatialomics approach to detect molecular signatures that often develop before morphological dysplasia becomes visible under standard microscopy. The test is indicated for patients diagnosed with non-dysplastic BE, specimens classified as indefinite for dysplasia, and patients with low-grade dysplasia.
The assay is designed to integrate directly into established pathology workflows using standard pinch biopsies obtained during routine endoscopy, eliminating the need for additional tissue collection procedures. According to the company, the test is supported by more than 17 peer-reviewed publications and has been evaluated in biopsy samples from more than 8,000 patients.
