Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova - Azienda Ospedaliera, Padova, Italy.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona, USA.
Cardiovasc Pathol. 2023 May-Jun;64:107494. doi: 10.1016/j.carpath.2022.107494. Epub 2022 Oct 29.
Dallas criteria (DC) and European Society of Cardiology criteria (ESCC) have provided valuable frameworks for the histologic diagnosis and classification of myocarditis in endomyocardial biopsy (EMB) specimens. However, the adaptation and the usage of these criteria are variable and depend on local practice settings and regions/countries. Moreover, several ancillary tests that are not included in the current criteria, such as immunohistochemistry (IHC) or viral polymerase chain reaction (PCR), have proven useful for the diagnosis of myocarditis.
As a joint effort from the Association for European Cardiovascular Pathology (AECVP) and the Society for Cardiovascular Pathology (SCVP), we conducted an online survey to understand the current practice of diagnosing myocarditis.
A total of 100 pathologists from 23 countries responded to the survey with the majority practicing in North America (45%) and Europe (45%). Most of the pathologists reported to examine less than 200 native heart biopsies per year (85%), and to routinely receive 3-5 fragments of tissue per case (90%). The number of hematoxylin-eosin-stained levels for each case varies from 1 to more than 9 levels, with 20% of pathologists routinely asking for more than 9 levels per case. Among the 100 pathologists, 52 reported to use the DC alone, 12 the ESCC alone, 28 both DC and ESCC and 8 reported to use neither the DC nor the ESCC. Overall, 80 pathologists reported to use the DC and 40 the ESCC. Use of DC alone is more common among North American pathologists compared to European ones (80% vs 32.6%) while use of ESCC alone is more common in Europe (20.9% vs 2.5%). IHC is utilized in either every case or selected cases by 79% of participants, and viral PCR is performed by 35% of participants. Variable terminologies are used in reporting, including both histological and clinical terms. The diagnosis of myocarditis is rendered even in the absence of myocyte injury (e.g., in cases of borderline or inactive/chronic myocarditis) by 46% respondents. The majority of the participants think it is time to update the current criteria (83%).
The survey data demonstrated that pathologists who render a myocarditis diagnosis practice with variable tissue preparation methods, use of ancillary studies, guideline usage, and reporting. This result highlights the clinically unmet need to update and standardize the current diagnostic criteria for myocarditis on EMB. Additional studies are warranted to establish standard of practice.
达拉斯标准（DC）和欧洲心脏病学会标准（ESCC）为心肌活检（EMB）标本中心肌炎的组织学诊断和分类提供了有价值的框架。然而，这些标准的应用和使用因当地实践环境以及所在地区/国家的不同而有所差异。此外，一些当前标准中未包含的辅助检测，如免疫组织化学（IHC）或病毒聚合酶链反应（PCR），已被证明对心肌炎的诊断有用。
作为欧洲心血管病理学协会（AECVP）和心血管病理学协会（SCVP）的联合努力，我们进行了一项在线调查，以了解目前诊断心肌炎的实践情况。
共有来自 23 个国家的 100 名病理学家对该调查做出了回应，其中大多数在北美（45%）和欧洲（45%）从事医学相关工作。大多数病理学家报告称，每年检查的原生心脏活检少于 200 例（85%），并且通常每例接收 3-5 个组织切片（90%）。每个病例的苏木精-伊红染色水平从 1 级到超过 9 级不等，20%的病理学家通常要求每个病例超过 9 级。在这 100 名病理学家中，52 名报告仅使用 DC，12 名报告仅使用 ESCC，28 名报告同时使用 DC 和 ESCC，8 名报告既不使用 DC 也不使用 ESCC。总体而言，80 名病理学家报告使用 DC，40 名报告使用 ESCC。与欧洲同行相比，北美病理学家更常单独使用 DC（80%比 32.6%），而欧洲同行更常单独使用 ESCC（20.9%比 2.5%）。79%的参与者在所有病例或选择病例中使用 IHC，35%的参与者进行病毒 PCR。报告中使用了可变的术语，包括组织学和临床术语。46%的受访者表示，即使在心肌损伤不存在的情况下（例如，在边界性或非活动性/慢性心肌炎的情况下），也会做出心肌炎的诊断。大多数参与者认为现在是更新当前标准的时候了（83%）。
调查数据表明，做出心肌炎诊断的病理学家在组织准备方法、辅助研究的使用、指南使用和报告方面存在差异。这一结果突显了在 EMB 上更新和标准化当前心肌炎诊断标准的临床需求。需要进一步的研究来建立标准的实践。
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