Newly developed and validated eosinophilic esophagitis histology scoring system and evidence that it outperforms peak eosinophil count for disease diagnosis and monitoring.
Newly developed and validated eosinophilic esophagitis histology scoring system and evidence that it outperforms peak eosinophil count for disease diagnosis and monitoring.
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DOI：
10.1111/dote.12470
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发表时间：
2017-02-01
期刊：
影响因子：
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通讯作者：
Rothenberg ME
中科院分区：
文献类型：
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作者：
Collins MH;Martin LJ;Alexander ES;Boyd JT;Sheridan R;He H;Pentiuk S;Putnam PE;Abonia JP;Mukkada VA;Franciosi JP;Rothenberg ME
嗜酸性食管炎（EoE）的诊断是通过症状，食管活检中每个高倍视野至少有15个上皮内嗜酸性粒细胞。其他病理特征未被强调。我们开发了一种食管活检组织学评分系统，可评估8个特征：嗜酸性粒细胞密度、基底层增生、嗜酸性粒细胞增多、嗜酸性粒细胞表面分层、细胞间隙扩张（DIS）、表面上皮改变、角化不良上皮细胞和固有层纤维化。使用4分量表（0正常; 3最大变化）对异常的严重程度（等级）和范围（阶段）进行评分。可靠性通过独立对活检进行评分的三位病理学家之间的强至中度一致性得到证明（P ≤ 0.008）。在104例受试者（34例未治疗，167例治疗）的201例活检（101例远端，100例近端）中，几个特征通常异常。与接受治疗的受试者相比，未接受治疗的受试者的中位分级和分期评分显着更高（P ≤ 0.0062）。与接受治疗的受试者相比，未接受治疗的受试者活检组织中与嗜酸性粒细胞计数无关的特征的等级评分显著更高（基底层增生P ≤ 0.024和DIS P ≤ 0.005），并且具有强相关性（R-square >0.67）。主成分分析确定了三个主成分，解释了78.2%的变化的功能。在逻辑回归模型中，两个主成分与治疗状态的相关性比对数远端峰值嗜酸性粒细胞计数（PEC）更密切（R平方17，曲线下面积（AUC）77.8 vs. R平方9，AUC 69.8）。总之，EoE组织学评分系统提供了一种客观评估食管中嗜酸性粒细胞数量以外的组织学变化的方法。重要的是，它区分治疗和未治疗的患者，使用在这种活检中常见的特征，并且在最低限度的培训后可由病理学家使用。这些数据为评价食管活检除PEC外的特征提供了依据和方法。
Eosinophilic esophagitis (EoE) is diagnosed by symptoms, and at least 15 intraepithelial eosinophils per high power field in an esophageal biopsy. Other pathologic features have not been emphasized. We developed a histology scoring system for esophageal biopsies that evaluates eight features: eosinophil density, basal zone hyperplasia, eosinophil abscesses, eosinophil surface layering, dilated intercellular spaces (DIS), surface epithelial alteration, dyskeratotic epithelial cells, and lamina propria fibrosis. Severity (grade) and extent (stage) of abnormalities were scored using a 4-point scale (0 normal; 3 maximum change). Reliability was demonstrated by strong to moderate agreement among three pathologists who scored biopsies independently (P ≤ 0.008). Several features were often abnormal in 201 biopsies (101 distal, 100 proximal) from 104 subjects (34 untreated, 167 treated). Median grade and stage scores were significantly higher in untreated compared with treated subjects (P ≤ 0.0062). Grade scores for features independent of eosinophil counts were significantly higher in biopsies from untreated compared with treated subjects (basal zone hyperplasia P ≤ 0.024 and DIS P ≤ 0.005), and were strongly correlated (R-square >0.67). Principal components analysis identified three principal components that explained 78.2% of the variation in the features. In logistic regression models, two principal components more closely associated with treatment status than log distal peak eosinophil count (PEC) (R-square 17, area under the curve (AUC) 77.8 vs. R-square 9, AUC 69.8). In summary, the EoE histology scoring system provides a method to objectively assess histologic changes in the esophagus beyond eosinophil number. Importantly, it discriminates treated from untreated patients, uses features commonly found in such biopsies, and is utilizable by pathologists after minimal training. These data provide rationales and a method to evaluate esophageal biopsies for features in addition to PEC.