Esposito Stefania, Valente Guido, Zavallone Annalisa, Guidali Paola, Rapa Anna, Oderda Giuseppina
Department of Pediatrics, University of Piemonte Orientale, Novara, Italy.
Hum Pathol. 2004 Jan;35(1):96-101. doi: 10.1016/j.humpath.2003.07.006.
Histological criteria for the diagnosis of reflux esophagitis include basal zone hyperplasia, stromal papillae elongation, and inflammatory infiltrate. However, endoscopic esophageal biopsy specimens may include little or no lamina propria. Intraepithelial T lymphocytes, seen in hematoxylin and eosin-stained sections as cells with irregular nuclear contours (CINC), may have a higher density in children with esophagitis. We evaluated the diagnostic accuracy of a numerical score built up by grading the "classical" parameters and its correlation with CINC density in grasp biopsy specimens obtained from children undergoing esophagogastroduodenoscopy with and without esophagitis. We analyzed esophageal biopsy specimens from 349 children (median age, 5 years) subdivided in 4 groups according to the previous routine histology report: group 1, 144 children with esophagitis; group 2, 65 controls; group 3, 51 children with dubious esophagitis; and group 4, 75 children with esophagitis on endoscopy but a normal histology report. A numerical value was assigned to each parameter; the sum of these values represented the histological score. We also evaluated intraepithelial CINC density (ie, number of CINC per high-power field). We separately analyzed histological sections with and without lamina propria. For both total score and for CINC density, we calculated a cutoff using a receiver operating characteristic curve. Cutoffs of 6 for score and of 4 for CINC density provided the best sensitivity and specificity. Sensitivity of the histological score was better in biopsy specimens containing lamina propria (94%) than in those without lamina propria (4%). Sensitivity of CINC density was satisfactory in both specimens with (78%) and without (75%) lamina propria. Specificity was satisfactory for both parameters. In conclusion, when lamina propria was present in sections of endoscopic esophageal biopsy specimens, histological score provided a better diagnostic accuracy for the diagnosis of esophagitis. However, when no lamina propria was present, as was the case in 67% of our children, CINC density had better sensitivity. In addition, this latter parameter showed esophageal mucosa damage in 34% of previously dubious cases or cases with esophagitis at endoscopy but a previous routine histology report of normal mucosa.
反流性食管炎的组织学诊断标准包括基底区增生、间质乳头延长和炎性浸润。然而，内镜下食管活检标本可能很少或不包含固有层。在苏木精-伊红染色切片中可见的上皮内T淋巴细胞，表现为核轮廓不规则的细胞（CINC），在食管炎患儿中密度可能更高。我们评估了通过对“经典”参数进行分级建立的数值评分的诊断准确性，以及其与从接受食管胃十二指肠镜检查的食管炎患儿和非食管炎患儿获取的钳取活检标本中CINC密度的相关性。我们分析了349名儿童（中位年龄5岁）的食管活检标本，根据之前的常规组织学报告将其分为4组：第1组，144名食管炎患儿；第2组，65名对照；第3组，51名疑似食管炎患儿；第4组，75名内镜检查显示食管炎但组织学报告正常的患儿。为每个参数赋予一个数值；这些数值的总和代表组织学评分。我们还评估了上皮内CINC密度（即每高倍视野中CINC的数量）。我们分别分析了有固有层和无固有层的组织学切片。对于总分和CINC密度，我们使用受试者工作特征曲线计算临界值。评分临界值为6，CINC密度临界值为4时，敏感性和特异性最佳。在含有固有层的活检标本中，组织学评分的敏感性（94%）高于无固有层的活检标本（4%）。在有固有层（78%）和无固有层（75%）的标本中，CINC密度的敏感性均令人满意。两个参数的特异性均令人满意。总之，当内镜下食管活检标本切片中存在固有层时，组织学评分对食管炎的诊断准确性更高。然而，当不存在固有层时，如我们67%的患儿那样，CINC密度具有更好的敏感性。此外，后一个参数在34%之前疑似病例或内镜检查显示食管炎但之前常规组织学报告为黏膜正常的病例中显示出食管黏膜损伤。
