van Grieken N C, Weiss M M, Meijer G A, Bloemena E, Lindeman J, Offerhaus G J, Meuwissen S G, Baak J P, Kuipers E J
Department of Gastroenterology, Free University Hospital, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
J Clin Pathol. 2001 Jan;54(1):63-9. doi: 10.1136/jcp.54.1.63.
BACKGROUND/AIMS: Grading of Helicobacter pylori induced atrophic gastritis using the updated Sydney system is severely limited by high interobserver variability. The aim of this study was to set up a quantitative test of gastric corpus mucosal atrophy in tissue sections and test its reproducibility and correlation with the Sydney scores of atrophy.
Mucosal atrophy was assessed in 124 haematoxylin and eosin stained corpus biopsy specimens by two experienced gastrointestinal pathologists (EB, JL) according to the updated Sydney system as none (n = 33), mild (n = 33), moderate (n = 33), or pronounced (n = 25). In each specimen, the proportions of glands, stroma, infiltrate, and intestinal metaplasia in the glandular zone were measured as volume percentages using a point counting method. The optimal point sample size, intra-observer and interobserver reproducibility, discriminative power for degrees of atrophy, and correlations with H pylori status were evaluated.
Counting 400 points in 200 fields of vision provided the smallest sample size that still had excellent intra-observer and interobserver reproducibility (r > or = 0.96). Overall, the volume percentage of glands (VPGL), infiltrate (VPI), and stroma (VPS) correlated well with the Sydney scores for atrophy (p < or = 0.003). However, no differences were found between non-atrophic mucosa and mild atrophy. No correlation was found between age and either the Sydney grade of atrophy or the VPGL or VPS. In non-atrophic mucosa and mild atrophy, H pylori positive cases showed a significantly higher VPI than did H pylori negative cases. A lower VPGL was seen in H pylori positive cases than in H pylori negative cases in the mild atrophy group. VPS did not correlate with H pylori status within each grade of atrophy.
Point counting is a powerful and reproducible tool for the quantitative analysis of mucosal corpus atrophy in tissue sections. These data favour the combination of "none" and "mild" atrophy into one category, resulting in a three class grading system for corpus atrophy, when using the updated Sydney system.
背景/目的：采用更新后的悉尼系统对幽门螺杆菌引起的萎缩性胃炎进行分级，因观察者间差异较大而受到严重限制。本研究的目的是建立一种对胃体黏膜萎缩进行定量检测的方法，并测试其可重复性以及与萎缩性胃炎悉尼评分的相关性。
两名经验丰富的胃肠病理学家（EB、JL）根据更新后的悉尼系统，对124例苏木精-伊红染色的胃体活检标本的黏膜萎缩情况进行评估，分为无萎缩（n = 33）、轻度萎缩（n = 33）、中度萎缩（n = 33）或重度萎缩（n = 25）。在每个标本中，采用点计数法测量腺区腺体、间质、浸润和肠化生的比例，以体积百分比表示。评估了最佳点样本量、观察者内和观察者间的可重复性、萎缩程度的鉴别能力以及与幽门螺杆菌状态的相关性。
在200个视野中计数400个点可提供最小样本量，且观察者内和观察者间仍具有出色的可重复性（r≥0.96）。总体而言，腺体体积百分比（VPGL）、浸润体积百分比（VPI）和间质体积百分比（VPS）与萎缩性胃炎的悉尼评分具有良好的相关性（p≤0.003）。然而，非萎缩性黏膜与轻度萎缩之间未发现差异。年龄与萎缩性胃炎悉尼分级、VPGL或VPS均无相关性。在非萎缩性黏膜和轻度萎缩中，幽门螺杆菌阳性病例的VPI显著高于幽门螺杆菌阴性病例。轻度萎缩组中，幽门螺杆菌阳性病例的VPGL低于幽门螺杆菌阴性病例。在各萎缩分级中，VPS与幽门螺杆菌状态均无相关性。
点计数法是对组织切片中胃体黏膜萎缩进行定量分析的一种强大且可重复的工具。当使用更新后的悉尼系统时，这些数据支持将“无”和“轻度”萎缩合并为一类，从而形成胃体萎缩的三级分级系统。
