胃前病变评估的观察者间变异性：肠上皮化生的一致性高于萎缩。
Interobserver variation in assessment of gastric premalignant lesions: higher agreement for intestinal metaplasia than for atrophy.
机构信息
Faculty of Medicine, University of Latvia, Riga, Latvia.
出版信息
Eur J Gastroenterol Hepatol. 2013 Jun;25(6):694-9. doi: 10.1097/MEG.0b013e32835e3397.
BACKGROUND
Either atrophy or intestinal metaplasia of the gastric mucosa are considered premalignant lesions. The new operative link for gastritis assessment staging system is based on the detection of atrophy, and the operative link for assessment of intestinal metaplasia staging system is based on the detection of intestinal metaplasia. Good interobserver agreement is necessary for identification of any premalignant condition.
AIMS
The aim of this study was to compare the agreement between findings of gastric atrophy and intestinal metaplasia by expert and general pathologists and to analyze the possible reasons behind any possible disagreement.
METHODS
Patients with dyspeptic symptoms, aged 55 years and above, without previous Helicobacter pylori eradication were enrolled and analyzed according to the updated Sydney Classification by two expert pathologists and an experienced general pathologist; the results were compared with the consensus driven by the two experts.
RESULTS
Gastric biopsy specimens from 121 patients (91 women) were included in the analysis; the mean age of the patients was 67.4 years. H. pylori infection was present in 61.2% of patients. The level of agreement between the general pathologist and the two experts (κ-value) was 0.12, 0.46, and 0.87, respectively, for detecting atrophy in the corpus; 0.77, 0.77, and 0.65, respectively, for detecting intestinal metaplasia in the corpus; 0.06, 0.51, and 0.54, respectively, for detecting atrophy in the antrum; and 0.69, 0.85, and 0.79, respectively, for detecting metaplasia in the antrum.
CONCLUSION
The agreement was substantially higher for intestinal metaplasia than for atrophy. This could result in discrepancies when the operative link for gastritis assessment and operative link for assessment of intestinal metaplasia staging systems are applied and can be caused by differences in the criteria used to define atrophy.
背景
胃黏膜的萎缩或肠化生均被视为癌前病变。新的胃炎评估分期系统的操作链接基于萎缩的检测，而肠化生评估分期系统的操作链接则基于肠化生的检测。良好的观察者间一致性对于识别任何癌前状态都是必要的。
目的
本研究旨在比较专家和普通病理学家对胃萎缩和肠化生的发现的一致性，并分析任何可能存在分歧的原因。
方法
对有消化不良症状、年龄 55 岁及以上、未经幽门螺杆菌根除的患者进行研究，按照悉尼分类的最新标准，由两位专家病理学家和一位经验丰富的普通病理学家进行分析；将结果与两位专家的共识进行比较。
结果
共有 121 例（91 例为女性）患者的胃活检标本纳入分析；患者的平均年龄为 67.4 岁。61.2%的患者存在 H. pylori 感染。普通病理学家与两位专家之间的一致性水平（κ 值）分别为 0.12、0.46 和 0.87，用于检测胃体萎缩；0.77、0.77 和 0.65，用于检测胃体肠化生；0.06、0.51 和 0.54，用于检测胃窦萎缩；0.69、0.85 和 0.79，用于检测胃窦肠化生。
结论
肠化生的一致性明显高于萎缩。当应用胃炎评估操作链接和肠化生评估分期系统操作链接时，可能会出现这种差异，这可能是由于用于定义萎缩的标准不同所致。
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