el-Zimaity H M, Graham D Y, al-Assi M T, Malaty H, Karttunen T J, Graham D P, Huberman R M, Genta R M
Department of Medicine, Veterans Affairs Medical Center, Houston, TX 77030, USA.
Hum Pathol. 1996 Jan;27(1):35-41. doi: 10.1016/s0046-8177(96)90135-5.
The histopathologic detection of Helicobacter pylori in gastric biopsy specimens is considered the gold standard for the diagnosis of H pylori infection. However, few studies have addressed the pathologists' reliability to detect the organism and to assess the degree of the related inflammatory changes. The objectives of this study were to determine the degree of agreement among the findings of four gastrointestinal pathologists in the semiquantitative evaluation of H pylori infection and gastritis. Three slides from specified areas of the stomach of 99 patients with and without H pylori infection were stained with the triple stain, coded, and examined independently by four pathologists. For each specimen, a visual analogue scale graded from 0 (absent/normal) to 5 (maximal intensity) was used to score (1) H pylori (2) neutrophils, and (3) atrophy. Data were analyzed using kappa-statistics. The kappa-coefficient for the detection of H pylori (present vs absent) was approximately .9 (excellent); for the intensity of infection, it was considerably lower on the 6-point scale (approximately .61) and improved slightly on an amalgamated 4-point scale (approximately .71). The agreement on presence or absence of neutrophils was excellent (kappa = .8) in antral biopsies and good (kappa = .67) in corpus biopsies. The kappa for the semiquantitative scoring of neutrophils was poor on the 6-point scale (approximately .43) and fair on the amalgamated scale (approximately .54). The interobserver agreement was the poorest in the evaluation of atrophy (presence, absence, categories, or group categories) with kappa coefficients varying from .08 and .29. This group of pathologists had a high level of concordance on the diagnosis of H pylori infection in any particular patient and a high index in the assessment of the intensity of infection. The agreement was less in the semiquantitative evaluation of active inflammation. When the evaluation concerned a loosely defined feature, such as atrophy, there was essentially no agreement among the pathologists. This study suggests the need for further assessments of pathologists' ability to provide reproducible diagnoses. These results also indicate that more stringent criteria for the diagnosis of "soft" histopathologic features (such as atrophy) are urgently needed.
胃活检标本中幽门螺杆菌的组织病理学检测被认为是诊断幽门螺杆菌感染的金标准。然而，很少有研究探讨病理学家检测该菌及评估相关炎症变化程度的可靠性。本研究的目的是确定四位胃肠道病理学家在幽门螺杆菌感染和胃炎的半定量评估结果之间的一致程度。对99例有或无幽门螺杆菌感染患者胃特定区域的三张玻片进行三联染色、编码，由四位病理学家独立检查。对每个标本，使用从0（无/正常）到5（最大强度）的视觉模拟量表对（1）幽门螺杆菌、（2）中性粒细胞和（3）萎缩进行评分。使用kappa统计分析数据。检测幽门螺杆菌（存在与否）的kappa系数约为0.9（优秀）；对于感染强度，在6分制量表上相当低（约0.61），在合并的4分制量表上略有改善（约0.71）。胃窦活检中中性粒细胞存在与否的一致性极佳（kappa = 0.8），胃体活检中良好（kappa = 0.67）。中性粒细胞半定量评分的kappa在6分制量表上较差（约0.43），在合并量表上一般（约0.54）。观察者间在萎缩评估（存在、不存在、类别或组类别）方面的一致性最差，kappa系数在0.08至0.29之间。这组病理学家在诊断任何特定患者的幽门螺杆菌感染方面具有高度一致性，在评估感染强度方面有较高指数。在活动性炎症的半定量评估中一致性较低。当评估涉及定义不明确的特征，如萎缩时，病理学家之间基本没有一致性。本研究表明需要进一步评估病理学家提供可重复诊断的能力。这些结果还表明迫切需要对“软性”组织病理学特征（如萎缩）的诊断制定更严格的标准。
