Vanstapel A, Vanuytsel T, De Hertogh G
Department of Pathology, University Hospitals Leuven, Belgium.
Department of Gastroenterology, University Hospitals Leuven, Belgium.
Acta Gastroenterol Belg. 2019 Apr-Jun;82(2):243-250.
The histologic diagnosis of eosinophilic esophagitis (EoE) is based on finding >15 eosinophils/high power field (HPF) on any level within the squamous epithelium of the esophagus. However, this criterion is based on a consensus statement, and controversy remains about the exact number of eosinophils/HPF needed to diagnose EoE. We aimed to determine eosinophilic peak counts in esophageal, gastric, and duodenal biopsies from suspected EoE patients, investigate the correlation between eosinophilic peak counts at different biopsy locations, and determine inter-observer and intra-observer reliability in reporting eosinophilic peak counts.
We selected 103 suspected EoE patients, who underwent an endoscopic procedure between June 1, 2010 and July 15, 2017. Eosinophilic peak counts in 1 HPF were obtained by a medical student and an experienced gastrointestinal pathologist.
Eosinophilic peak counts in suspected EoE patients are highly variable (esophagus : IQR 66-178, median 110 ; stomach : IQR 2-10, median 3 ; duodenum : IQR 16-44, median 25). No significant correlation was found between eosinophilic peak counts at different biopsy locations. The inter-observer and intra-observer correlation for reporting eosinophilic peak counts was in the nearperfect range (ρ ranged from 0.93 to 0.99, P<0.0001).
Our data suggest that the accuracy of determining eosinophilic peak counts is not influenced by the pathologist's experience. Therefore, variability in reporting eosinophilic peak counts is unlikely to influence the diagnostic accuracy of EoE. To further improve diagnostic accuracy, investigation of other histologic features observed in EoE is needed.
嗜酸性粒细胞性食管炎（EoE）的组织学诊断基于在食管鳞状上皮的任何层面发现每高倍视野（HPF）有超过15个嗜酸性粒细胞。然而，该标准基于一项共识声明，对于诊断EoE所需的每HPF嗜酸性粒细胞的确切数量仍存在争议。我们旨在确定疑似EoE患者食管、胃和十二指肠活检组织中的嗜酸性粒细胞峰值计数，研究不同活检部位嗜酸性粒细胞峰值计数之间的相关性，并确定观察者间和观察者内报告嗜酸性粒细胞峰值计数的可靠性。
我们选取了103例疑似EoE患者，他们在2010年6月1日至2017年7月15日期间接受了内镜检查。一名医学生和一名经验丰富的胃肠病理学家获取了1个HPF中的嗜酸性粒细胞峰值计数。
疑似EoE患者的嗜酸性粒细胞峰值计数高度可变（食管：四分位间距66 - 178，中位数110；胃：四分位间距2 - 10，中位数3；十二指肠：四分位间距16 - 44，中位数25）。不同活检部位的嗜酸性粒细胞峰值计数之间未发现显著相关性。报告嗜酸性粒细胞峰值计数的观察者间和观察者内相关性处于近乎完美的范围（ρ范围为0.93至0.99，P<0.0001）。
我们的数据表明，确定嗜酸性粒细胞峰值计数的准确性不受病理学家经验的影响。因此，报告嗜酸性粒细胞峰值计数的变异性不太可能影响EoE的诊断准确性。为进一步提高诊断准确性，需要对EoE中观察到的其他组织学特征进行研究。
