Flanagan Margaret E, Marshall Desiree A, Shofer Jane B, Montine Kathleen S, Nelson Peter T, Montine Thomas J, Keene C Dirk
Department of Pathology, Stanford University, Stanford, CA, USA.
Department of Pathology, University of Washington, Seattle, WA, USA.
J Neuropathol Exp Neurol. 2017 Jan 1;76(1):39-43. doi: 10.1093/jnen/nlw104.
Concerns regarding resource expenditures have been expressed about the 2012 NIA-AA Sponsored Guidelines for neuropathologic assessment of Alzheimer disease (AD) and related dementias. Here, we investigated a cost-reducing Condensed Protocol and its effectiveness in maintaining the diagnostic performance of Guidelines in assessing AD, Lewy body disease (LBD), microvascular brain injury, hippocampal sclerosis (HS), and congophilic amyloid angiopathy (CAA). The Condensed Protocol consolidates the same 20 regions into 5 tissue cassettes at ∼75% lower cost. A 28 autopsy brain-retrospective cohort was selected for varying levels of neuropathologic features in the Guidelines (Original Protocol), as well as an 18 consecutive autopsy brain prospective cohort. Three neuropathologists at 2 sites performed blinded evaluations of these cases. Lesion specificity was similar between Original and Condensed Protocols. Sensitivities for AD neuropathologic change, LBD, HS, and CAA were not substantially impacted by the Condensed Protocol, whereas sensitivity for microvascular lesions (MVLs) was decreased. Specificity for CAA was decreased using the Condensed Protocol when compared with the Original Protocol. Our results show that the Condensed Protocol is a viable alternative to the NIA-AA guidelines for AD neuropathologic change, LBD, and HS, but not MVLs or CAA, and may be a practical alternative in some practice settings.
人们对2012年美国国立衰老研究所（NIA）和美国国立神经疾病与中风研究所（AA）联合发起的阿尔茨海默病（AD）及相关痴呆症神经病理学评估指南的资源支出表示担忧。在此，我们研究了一种成本降低的简化方案及其在维持该指南对AD、路易体病（LBD）、微血管脑损伤、海马硬化（HS）和嗜刚果红性淀粉样血管病（CAA）评估的诊断性能方面的有效性。简化方案将相同的20个区域整合到5个组织盒中，成本降低约75%。选取了一个包含28例尸检脑的回顾性队列，这些病例在指南（原始方案）中有不同程度的神经病理学特征，以及一个包含18例连续尸检脑的前瞻性队列。两个地点的三位神经病理学家对这些病例进行了盲法评估。原始方案和简化方案之间的病变特异性相似。简化方案对AD神经病理学改变、LBD、HS和CAA的敏感性没有受到实质性影响，而对微血管病变（MVL）的敏感性有所降低。与原始方案相比，使用简化方案时CAA的特异性降低。我们的结果表明，简化方案对于AD神经病理学改变、LBD和HS是NIA-AA指南的可行替代方案，但对于MVL或CAA则不然，并且在某些实践环境中可能是一种实用的替代方案。
