A histopathological classification scheme for abdominal aortic aneurysm disease.
A histopathological classification scheme for abdominal aortic aneurysm disease.
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DOI：
10.1016/j.jvssci.2021.09.001
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Lindeman JH
中科院分区：
文献类型：
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作者：
Bruijn LE;van Stroe Gómez CG;Curci JA;Golledge J;Hamming JF;Jones GT;Lee R;Matic L;van Rhijn C;Vriens PW;Wågsäter D;Xu B;Yamanouchi D;Lindeman JH
已经发布了胸主动脉瘤（TAA）和炎性主动脉疾病的两种共识组织病理学分类，以促进临床决策和研究间比较。然而，这些共识分类并不特别包括腹主动脉瘤（AAA）。鉴于其高患病率和现有的深刻的病理生理学知识差距，将共识分类方案扩展到AAA将是非常有用的。本研究的目的是测试的适用性，并在必要时调整，已发布的共识分类方案的AAA级。在2002年至2013年期间进行的择期和急诊开放性动脉瘤修复术期间收集了72份AAA前外侧壁样本。进行组织学分析（苏木精和伊红以及Movat Pentachrome）和（半定量和定性）分级，以绘制AAA的组织学方面。免疫组织化学进行可视化方面的适应性和先天性免疫系统，并在AAA动脉粥样硬化病变的更详细的分析。由于现有的共识分类方案不能充分捕获AAA疾病的各个方面，因此设计了AAA特异性11点组织病理学共识分类。该分类的系统应用表明AAA有几个普遍特征（例如，[几乎]完全弹性蛋白溶解），但其他方面（例如，炎症和动脉粥样硬化病变）有相当大的差异。这是第一个多参数组织病理学AAA共识分类，说明了胸动脉瘤和腹动脉瘤之间的鲜明组织学对比。AAA疾病的建议评分系统的价值说明其鉴别能力，以确定患者的样本与非经典（遗传）变异的AAA疾病。腹主动脉瘤（AAA）疾病的病理生理学仍然是一个谜。组织学评价对于评估AAA疾病的组织重塑和空间方面至关重要。已经为主动脉病变设计了组织学分类方案。不幸的是，这些方案没有专门解决最常见的主动脉病变，AAA疾病。为了便于研究间比较和AAA疾病的病理生理学理解，我们在这里提出了一个多参数共识AAA组织病理学分类方案。该方案明确区分了AAA疾病和胸主动脉瘤疾病。AAA分类系统的系统实施表明AAA疾病存在大量的生物学变异，并强调需要足够的组规模以充分涵盖自然变异性。举例说明分类系统的诊断价值。
Two consensus histopathological classifications for thoracic aortic aneurysms (TAAs) and inflammatory aortic diseases have been issued to facilitate clinical decision-making and inter-study comparison. However, these consensus classifications do not specifically encompass abdominal aortic aneurysms (AAAs). Given its high prevalence and the existing profound pathophysiologic knowledge gaps, extension of the consensus classification scheme to AAAs would be highly instrumental. The aim of this study was to test the applicability of, and if necessary to adapt, the issued consensus classification schemes for AAAs. Seventy-two AAA anterolateral wall samples were collected during elective and emergency open aneurysm repair performed between 2002 and 2013. Histologic analysis (hematoxylin and eosin and Movat Pentachrome) and (semi-quantitative and qualitative) grading were performed in order to map the histological aspects of AAA. Immunohistochemistry was performed for visualization of aspects of the adaptive and innate immune system, and for a more detailed analysis of atherosclerotic lesions in AAA. Because the existing consensus classification schemes do not adequately capture the aspects of AAA disease, an AAA-specific 11-point histopathological consensus classification was devised. Systematic application of this classification indicated several universal features for AAA (eg, [almost] complete elastolysis), but considerable variation for other aspects (eg, inflammation and atherosclerotic lesions). This first multiparameter histopathological AAA consensus classification illustrates the sharp histological contrasts between thoracic and abdominal aneurysms. The value of the proposed scoring system for AAA disease is illustrated by its discriminatory capacity to identify samples from patients with a nonclassical (genetic) variant of AAA disease. The pathophysiology of abdominal aortic aneurysm (AAA) disease remains an enigma. Histological evaluation is critical for appreciation of the tissue remodeling and spatial aspects of AAA disease. Histopathological classification schemes have been devised for aortic pathology. Unfortunately, these schemes do not specifically address the most common aortic pathology, AAA disease. In order to facilitate interstudy comparisons and pathophysiologic understanding of AAA disease, we here present a multiparameter consensus histopathological AAA classification scheme. The scheme clearly discriminates AAA disease from thoracic aortic aneurysm disease. Systematic implementation of this AAA classification system indicates a substantial biological variation for AAA disease, and stresses the need for adequate group sizes in order to adequately cover the natural variability. Examples illustrating the diagnostic value of the classification system are provided.