OBSERVER VARIATION IN THE ASSESSMENT OF CHRONIC GASTRITIS ACCORDING TO THE SYDNEY SYSTEM
OBSERVER VARIATION IN THE ASSESSMENT OF CHRONIC GASTRITIS ACCORDING TO THE SYDNEY SYSTEM
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DOI：
10.1111/j.1365-2559.1994.tb01349.x
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发表时间：
1994-10-01
期刊：
影响因子：
6.4
通讯作者：
DIXON, MF
中科院分区：
文献类型：
--
作者：
ANDREW, A;WYATT, JI;DIXON, MF
悉尼胃炎分类系统的主要目的是提高组织病理学报告的一致性，并为组织学特征分级提供灵活的规则矩阵。我们试图确定在悉尼系统的应用中，病理学家之间的观察者间的一致程度。三位组织病理学家独立检查了69例消化不良患者的两个胃窦和两个胃体活检组织的H&E、阿尔新蓝/PAS和改良Giemsa染色切片。剔除5个不合适的病例后，每位观察者根据悉尼系统标准对胃窦和胃体的慢性炎症、多形性活动、萎缩、肠化生和幽门螺杆菌密度进行0~3级评分。用Kappa统计检验最终诊断的配对一致性和组织学分级的总体一致性和条件性一致性。对最终诊断的符合率为83-94%，卡伯值为0.699(“良好”)到0.887(“优”)。诊断幽门螺杆菌阳性胃炎的条件概率为99%，但对幽门螺杆菌阴性胃炎、反应性胃炎甚至正常活检的认识存在更大的分歧。总体上符合程度从70%的胃窦萎缩到94%的肠化生，在‘中等’或‘良好’卡伯值。我们得出结论，悉尼系统中描述的诊断和分级标准可以被组织病理学家始终如一地应用。这些发现突显了它在日常实践中的潜在用处。
The main aims of the Sydney system for the classification of gastritis are to improve uniformity in histopathological reporting and to provide a flexible matrix of rules for grading the histological, features. We sought to determine the level of interobserver agreement between pathologists in the application of the Sydney system. Three histopathologists independently examined H & E, alcian blue/PAS and modified Giemsa stained sections of two antral and two corpus gastric biopsies from 69 consecutive dyspeptic patients. After elimination of five unsuitable cases, each observer graded chronic inflammation, polymorph activity, atrophy, intestinal metaplasia and Helicobacter pylori density in the antrum and corpus on a 0-3 scale according to the Sydney system criteria. The pairwise agreement on final diagnosis and the overall and conditional agreement on histological grades were examined by kappa statistics. Agreement on the final diagnosis ranged from 83-94% with kappa values of 0.699 ('good') to 0.887 ('excellent'). Conditional probability of agreement on a diagnosis of H. pylori positive gastritis was 99%, but wider disagreements were apparent in the recognition of H. pylori negative gastritis, reactive gastritis and even normal biopsies. Overall agreement for grade ranged from 70% for antral atrophy to 94% for intestinal metaplasia in the corpus with 'moderate' or 'good' kappa values. We conclude that the diagnostic and grading criteria described in the Sydney system can be applied consistently by histopathologists. The findings underline its potential usefulness in routine practice.