Department of Biology, Johns Hopkins University, Baltimore, Maryland, USA.
Institute of Translational Health Sciences, Seattle, Washington, USA.
Pain Med. 2023 Apr 3;24(4):425-441. doi: 10.1093/pm/pnac168.
Pathology can provide crucial insights into the etiology of disease. The goal of this review is to evaluate the rigor of histopathology reports of Complex Regional Pain Syndrome (CRPS).
A systematic search of multiple databases identified papers that described amputation for CRPS with pathology findings. Control pathology articles were randomly chosen from the same journals. Landmark articles in Surgical Pathology were previously identified. Papers were categorized by the use of histology: Anatomic (microscopic description), Diagnostic (binary result), and Substrate (special studies only). A novel Histopathology Score assigned 1 point for each of 10 History elements and 15 Pathology elements. All articles were scored and analyzed by appropriate statistics.
The search identified 22 CRPS, 50 Control and 50 Landmark articles. Multivariable analysis of the Pathology Score showed a significantly higher score for Anatomic vs Non-Anatomic papers (Incidence Rate Ratio (IRR) 1.54, P < .001) and Landmark vs CRPS articles (IRR 1.39, P value .003). CRPS papers reported some elements infrequently: diagnostic criteria (31.8%), routine stain (50%), any clinic-pathologic correlation (40.9%), and sample size >2 (27.3%).
The Pathology Score is a useful quality assessment tool to evaluate studies. As expected, Anatomic papers scored significantly higher than Non-Anatomic papers. CRPS papers had small sample sizes (median 1) and infrequent reporting of diagnostic criteria, routine stain, any clinical pathologic correlation. These particular elements are crucial for analyzing and reviewing pathologic features. The analysis explains why it is quite difficult to write a meaningful systematic review of CRPS histology at this time.
病理学可以提供对疾病病因的重要见解。本综述的目的是评估复杂性区域疼痛综合征（CRPS）的组织病理学报告的严谨性。
通过系统搜索多个数据库，确定了描述 CRPS 截肢术且具有病理学发现的论文。从同一期刊中随机选择对照病理学文章。先前确定了外科病理学中的标志性文章。根据组织学使用情况对论文进行分类：解剖学（微观描述）、诊断学（二元结果）和底物（仅特殊研究）。一种新的组织病理学评分对 10 个历史元素和 15 个病理学元素中的每一个都记 1 分。对所有文章进行评分并进行适当的统计学分析。
搜索确定了 22 篇 CRPS、50 篇对照和 50 篇标志性文章。组织病理学评分的多变量分析显示，解剖学与非解剖学论文之间的评分明显更高（发病率比（IRR）为 1.54，P < 0.001），标志性与 CRPS 文章之间的评分也更高（IRR 为 1.39，P 值 < 0.003）。CRPS 论文很少报告某些元素：诊断标准（31.8%）、常规染色（50%）、任何临床病理相关性（40.9%）和样本量>2（27.3%）。
组织病理学评分是评估研究的有用质量评估工具。不出所料，解剖学论文的评分明显高于非解剖学论文。CRPS 论文的样本量较小（中位数为 1），且很少报告诊断标准、常规染色、任何临床病理相关性。这些特定元素对于分析和审查病理特征至关重要。分析解释了为什么目前很难对 CRPS 组织学进行有意义的系统综述。
