Department of Pathology & Immunology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35233, USA.
Ann Diagn Pathol. 2022 Feb;56:151840. doi: 10.1016/j.anndiagpath.2021.151840. Epub 2021 Oct 13.
Autoimmune gastritis (AIG) is a clinicopathologic diagnosis requiring characteristic histopathology and correlation with laboratory work-up. To better understand how the diagnosis of AIG is made and reported in the pathology community, we conducted an anonymous web-based survey which was circulated among a diverse group of pathologists. Excluding trainees there were 64 respondents: 25 academic gastrointestinal pathologists (AGI, 39%), 22 academic general pathologists (AGP, 34%), 17 private general pathologists (PP, 27%). Our survey results highlighted variations in work-up and sign-out practices. The type of metaplasia needed to diagnose AIG lacked consensus. There was variation in accurate interpretation of immunostains with a trend towards more accurate diagnosis of enterochromaffin-like (ECL) cell hyperplasia by AGI (92%) and AGP (95%) than PP (71%) (p = 0.07). G-cells in antrum on neuroendocrine immunostain, a mimicker of ECL cell hyperplasia, was more frequently misdiagnosed by PP/ AGP (44%), versus AGI (12%) (p = 0.02). A triple immunostain panel (H. pylori, neuroendocrine, gastrin) was used in the work-up of AIG by 72% of AGI versus 23% AGP and 12% PP (p = 0.000061). The less-specific term "atrophic gastritis" was used in the diagnostic line more by respondents with >10 years sign-out experience compared with others (p = 0.04). In conclusion, the survey results highlighted deficiencies in the interpretation of neuroendocrine immunostains which is crucial for AIG diagnosis, as well as variation in reporting practices and definitions. Uniform criteria and terminology are needed in this field to improve communication with clinicians, resulting in appropriate testing and follow-up.
自身免疫性胃炎（AIG）是一种临床病理诊断，需要有特征性的组织病理学和与实验室检查结果相关联。为了更好地了解病理学界如何做出和报告 AIG 的诊断，我们对一组不同的病理学家进行了匿名的网络调查。除了实习生，共有 64 名受访者：25 名学术胃肠道病理学家（AGI，39%），22 名学术普通病理学家（AGP，34%），17 名私人普通病理学家（PP，27%）。我们的调查结果突出了工作流程和报告实践的差异。诊断 AIG 所需的化生类型缺乏共识。免疫组化的准确解读存在差异，AGI（92%）和 AGP（95%）比 PP（71%）更准确地诊断肠嗜铬样（ECL）细胞增生的趋势（p=0.07）。神经内分泌免疫染色的胃窦 G 细胞是 ECL 细胞增生的模拟物，PP/AGP 更频繁地误诊为 44%，而 AGI 为 12%（p=0.02）。72%的 AGI 在 AIG 的工作流程中使用三联免疫组化（H. pylori、神经内分泌、胃泌素），而 AGP 为 23%，PP 为 12%（p=0.000061）。有 10 年以上报告经验的受访者在诊断线上更频繁地使用不太具体的术语“萎缩性胃炎”，而其他受访者则较少使用（p=0.04）。总之，调查结果突出了神经内分泌免疫组化解读的不足，这对 AIG 的诊断至关重要，同时也存在报告实践和定义的差异。该领域需要统一的标准和术语，以改善与临床医生的沟通，从而进行适当的检测和随访。
