Friendswood, Texas – September 28, 2026 -- Castle Biosciences, Inc. (Nasdaq: CSTL) said a new peer-reviewed study found its TissueCypher Barrett's Esophagus Test prompted clinicians to change management recommendations in 90% of cases involving patients with non-dysplastic Barrett's esophagus (NDBE).
The case series, published in Foregut: The Journal of the American Foregut Society, evaluated 30 NDBE patients tested as part of clinical care at Keck Medical Center of the University of Southern California (USC).
Test reclassifies risk within a population considered uniformly low-risk
TissueCypher classified 17% of the 30 patients as intermediate or high risk for progression to high-grade dysplasia or esophageal adenocarcinoma within five years, while 83% were confirmed low risk. All patients had received the same NDBE diagnosis prior to testing.
Higher-risk results triggered escalation for every affected patient
Clinicians escalated management for 100% of patients with intermediate- or high-risk results, including endoscopic eradication therapy for four patients and shorter-interval surveillance for one.
Low-risk results led to de-escalation in 84% of cases
Among patients classified as low risk, 84% saw their management de-escalated, through extended surveillance intervals or discontinuation of planned endoscopic eradication therapy.
Test results shaped decisions or confidence for nearly all patients
TissueCypher results changed management recommendations or increased physician confidence in existing plans for 97% of the 30 patients studied.
Study author Caitlin C. Houghton, M.D., a board-certified foregut surgeon at Keck Medicine of USC, said the test allowed clinicians to tailor surveillance or treatment intensity to each patient's individual progression risk rather than relying solely on the shared NDBE diagnosis.
Findings were also presented at a national surgical congress
Katie M. Galvin, M.D., of the Keck School of Medicine of USC, presented the data on Sept. 27 at the American College of Surgeons Clinical Congress 2026 in Washington, D.C., during a Quick-Shots session on bariatric and foregut topics.
TissueCypher is backed by more than 17 peer-reviewed publications and has been studied in biopsies from more than 8,000 patients, according to Castle Biosciences. The test uses an AI-derived spatialomics approach applied to standard esophageal pinch biopsies, requiring no additional procedures.