El-Zimaity H M, Graham D Y
Department of Medicine, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 77030, USA.
Hum Pathol. 1999 Jan;30(1):72-7. doi: 10.1016/s0046-8177(99)90303-9.
Pathologists are frequently asked to evaluate gastric mucosal biopsy specimens for the presence of Helicobacter pylori infection and for potentially important changes such as intestinal metaplasia. No agreed-on system is both available and prospectively shown to provide reliable estimates of the underlying pathological condition. The Sydney System combined topographical, morphological, and causative information for evaluation of gastric biopsy specimens and provided recommendations regarding biopsy site and number. Both the biopsy sites and number were changed in 1994. Gastric biopsy specimens from patients who had multiple biopsies performed on predetermined sites were examined to compare the original and the revised Sydney Systems for the detection of intestinal metaplasia and H pylori. The diagnosis based on both versions of the Sydney System was then compared with that obtained by evaluating all specimens. Forty-six patients were studied, 20 with H pylori infection and 36 with intestinal metaplasia. Using either version of the Sydney System correctly categorized H pylori infection status in 100%. Both the original and the revised Sydney recommendations seriously underestimated the prevalence of intestinal metaplasia. Intestinal metaplasia was missed in more than 50% of those with confirmed intestinal metaplasia. No set or site of biopsy specimens was found that could reliably exclude the presence of intestinal metaplasia. Current and future studies that use the Sydney System as basis for detecting intestinal metaplasia are not likely to be reliable. Likewise, using the Sydney System to test posttherapy or with time will not accurately reflect the true status of intestinal metaplasia.
病理学家经常被要求评估胃黏膜活检标本，以确定是否存在幽门螺杆菌感染以及是否存在诸如肠化生等潜在的重要病变。目前尚无一种公认的系统既可用又能前瞻性地提供对潜在病理状况的可靠评估。悉尼系统结合了拓扑学、形态学和病因学信息来评估胃活检标本，并就活检部位和数量提供了建议。1994年，活检部位和数量都发生了变化。对在预定部位进行多次活检的患者的胃活检标本进行检查，以比较原始版和修订版悉尼系统在检测肠化生和幽门螺杆菌方面的效果。然后将基于两个版本悉尼系统的诊断结果与通过评估所有标本获得的诊断结果进行比较。共研究了46例患者，其中20例有幽门螺杆菌感染，36例有肠化生。使用任何一个版本的悉尼系统对幽门螺杆菌感染状态的正确分类率均为100%。原始版和修订版悉尼建议都严重低估了肠化生的患病率。在确诊为肠化生的患者中，超过50%的患者漏诊了肠化生。未发现任何一组活检标本或活检部位能够可靠地排除肠化生的存在。目前以及未来以悉尼系统为基础检测肠化生的研究可能都不可靠。同样，使用悉尼系统来检测治疗后或随时间变化的情况也无法准确反映肠化生的真实状况。
