Galindo-Moreno Pablo, López-Martínez Jesús, Caba-Molina Mercedes, Ríos-Pelegrina Rosa, Torrecillas-Martínez Laura, Monje Alberto, Mesa Francisco, Chueca Natalia, García-García Federico, O'Valle Francisco
Eur J Oral Implantol. 2017;10(4):453-463.
To examine differences in morphology and in immunophenotype subsets between chronic periodontitis (CP) and peri-implantitis (P-I) lesions and to test the diagnostic agreement (CP vs P-I) among three independent observers, based on histopathological features.
This observational cross-sectional study included 15 gingival biopsies of CP lesions and 15 biopsies of P-I lesions for double-blinded examination by three independent pathologists. Inflammatory infiltrate intensity was assessed semiquantitatively on a 4-point scale, determining the percentage of lymphocytes, plasma cells, monocytes/macrophages, and granulocytes and the presence/absence of bacterial colonies. Immunohistochemical analyses were performed to verify the inflammatory infiltrate subset data (CD45, CD38, CD68 and myeloperoxidase [MPO]-positive), and number of vessels. Kappa statistic was used to evaluate the degree of diagnostic concordance among examiners.
Inflammatory infiltrate was significantly more severe in P-I cases (P = 0.01), which showed a significantly higher percentage of plasma cells (P = 0.004) than in CP cases. Immunohistochemically, the percentage of leukocyte subsets was generally lower in CP (CD38: 32.05%; CD68: 6.45% and MPO: 8.62%) than in P-I (CD38: 61.13%; CD68: 9.09% and MPO: 7.47%) (CD38 P = 0.001, P = 0.955 and P = 0.463, for remaining subsets, respectively; Mann-Whitney U-test). The inter-observer diagnostic agreement was poor or slight (kappa = -0.18 to 0.13).
Despite the significantly more severe general inflammatory infiltrate and plasma cells in P-I cases, it proved difficult to detect reliable differential morphological features based on histopathological images of these CP and P-I soft-tissue samples, obtaining low inter-observer and intra-observer diagnostic agreement. Conflict of interest statement: This investigation was partially supported by Research Groups #CTS-138 and #CTS-583 (Junta de Andalucía, Spain). No conflict of interest.
研究慢性牙周炎（CP）和种植体周围炎（P-I）病变在形态学和免疫表型亚群方面的差异，并基于组织病理学特征测试三位独立观察者之间的诊断一致性（CP与P-I）。
这项观察性横断面研究纳入了15例CP病变的牙龈活检组织和15例P-I病变的活检组织，由三位独立病理学家进行双盲检查。炎症浸润强度采用4分制进行半定量评估，确定淋巴细胞、浆细胞、单核细胞/巨噬细胞和粒细胞的百分比以及细菌菌落的有无。进行免疫组织化学分析以验证炎症浸润亚群数据（CD45、CD38、CD68和髓过氧化物酶[MPO]阳性）以及血管数量。使用kappa统计量评估检查者之间的诊断一致性程度。
P-I病例的炎症浸润明显更严重（P = 0.01），其浆细胞百分比显著高于CP病例（P = 0.004）。免疫组织化学分析显示，CP中白细胞亚群的百分比通常低于P-I（CD38：32.05%；CD68：6.45%和MPO：8.62%）（P-I中CD38：61.13%；CD68：9.09%和MPO：7.47%）（CD38 P = 0.001，其余亚群分别为P = 0.955和P = 0.463；曼-惠特尼U检验）。观察者间的诊断一致性较差或轻微（kappa = -0.18至0.13）。
尽管P-I病例中总体炎症浸润和浆细胞明显更严重，但基于这些CP和P-I软组织样本的组织病理学图像，难以检测到可靠的鉴别形态学特征，观察者间和观察者内的诊断一致性较低。利益冲突声明：本研究部分得到了研究小组#CTS-138和#CTS-583（西班牙安达卢西亚自治区）的支持。无利益冲突。
