Interobserver variation in the histopathological assessment of Helicobacter pylori gastritis
Interobserver variation in the histopathological assessment of Helicobacter pylori gastritis
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DOI：
10.1016/s0046-8177(96)90135-5
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发表时间：
1996-01-01
期刊：
影响因子：
3.3
通讯作者：
Genta, RM
中科院分区：
文献类型：
--
作者：
ElZimaity, HMT;Graham, DY;Genta, RM
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，很少有研究已经解决了病理学家的可靠性，以检测有机体和评估相关的炎症变化的程度。本研究的目的是确定四位胃肠道病理学家在半定量评价幽门螺杆菌感染和胃炎的结果之间的一致程度。从99例有和没有幽门螺杆菌感染的患者的胃的指定区域的三个载玻片用三重染色剂染色，编码，并由四名病理学家独立检查。对于每个标本，使用从0（不存在/正常）到5（最大强度）分级的视觉模拟量表对（1）幽门螺杆菌（2）中性粒细胞和（3）萎缩进行评分。使用卡帕统计分析数据。幽门螺杆菌检测的κ系数（存在与不存在）与0.9（极好）相似;感染强度在B量表上显著降低（与0.61相似），在合并的4量表上略有改善（与0.71相似）。中性粒细胞的存在或不存在的一致性在胃窦活检中是极好的（kappa = 0.8），在体部活检中是良好的（kappa = 0.67）。中性粒细胞半定量评分的Kappa值在B点量表上较差（与0.43相似），在合并量表上一般（与0.54相似）。在评估萎缩（存在、不存在、类别或组类别）方面，观察者间一致性最差，kappa系数为0.08至0.29。这组病理学家对任何特定患者的幽门螺杆菌感染诊断具有高度一致性，并且在感染强度评估中具有高指数。在活动性炎症的半定量评价中，一致性较低。当评价涉及到一个松散定义的特征时，如萎缩，病理学家之间基本上没有达成一致。这项研究表明，需要进一步评估病理学家的能力，提供可重复的诊断。这些结果还表明，迫切需要更严格的标准来诊断“软”组织病理学特征（如萎缩）。桑德斯公司
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 similar to.9 (excellent); for the intensity of infection, it was considerably lower on the B-point scale (similar to.61) and improved slightly on an amalgamated 4-point scale (similar to.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 B-point scale (similar to.43) and fair on the amalgamated scale (similar to.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.Copyright (C) 1996 by W.B. Saunders Company