Neuropathological consensus criteria for the evaluation of Lewy pathology in post-mortem brains: a multi-centre study.
Neuropathological consensus criteria for the evaluation of Lewy pathology in post-mortem brains: a multi-centre study.
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DOI：
10.1007/s00401-020-02255-2
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发表时间：
2021-03
影响因子：
12.7
通讯作者：
McKeith IG
中科院分区：
文献类型：
--
作者：
Attems J;Toledo JB;Walker L;Gelpi E;Gentleman S;Halliday G;Hortobagyi T;Jellinger K;Kovacs GG;Lee EB;Love S;McAleese KE;Nelson PT;Neumann M;Parkkinen L;Polvikoski T;Sikorska B;Smith C;Grinberg LT;Thal DR;Trojanowski JQ;McKeith IG
目前，路易体病(LBD)的神经病理诊断可以根据几种分期系统来陈述，其中包括Braak Louy Body分期(Braak)、McKeith及其同事的共识标准(McKeith)、Leverenz及其同事的改良McKeith系统(Leverenz)以及比奇及其同事的统一分期系统(BATCH)。所有这些系统都使用定义的皮质和皮质下区域的路易氏病理(LP；即路易小体和路易氏突起)的半定量评分(4级或5级)。虽然这些系统被广泛使用，但其中一些系统存在评分员间可靠性低和/或无法明确地对所有LP病例进行分类的问题。为了解决这些局限性，我们设计了一种新的系统，LP共识标准(LPC)，它基于McKeith系统，但采用了一种二分法来对LP进行评分(即“缺席”和“存在”)，并包括杏仁核为主和仅嗅觉为主的阶段。对来自纽卡斯尔脑组织资源中心和宾夕法尼亚大学脑库提供的34例LP患者脑干、边缘系统、新皮质和嗅球的α-突触核蛋白染色的切片进行扫描和评估，16名评分员根据Braak、McKeith、Leverenz、比奇和LPC系统对每个病例进行诊断分类。此外，根据神经病理报告中可获得的LP评分，JT(UPBB)和JA(Nbtr)根据所有的分期系统对这些病例进行了分类。这些病例分别来自UPBB(n = )和NBTR134。McKeith、Leverenz和LPC系统达到了良好的水平(克里彭多夫的α≈为0.6%)，而布拉克和比奇系统的评分员间可靠性分别较低(克里彭多夫的α≈为0.4%)。使用LPC系统，大多数评分员都可以明确地对所有案例进行分类，当使用比奇系统时，这一比例也达到97.1%。然而，使用Leverenz(11.8%)、McKeith(26.5%)或Braak(29.4%)系统时，相当大一部分病例无法分类。根据LPC系统分类的新皮质LP与痴呆的5.9OR(p <； 0.0001)和202例uPBB的3.14OR3.14(p = 0.0001)相关。我们确定，LPC系统具有良好的重复性，并允许将所有病例分类为不同的类别。我们希望它在常规诊断实践中是可靠和有用的，因此建议它应该成为未来对LP进行基本尸检评估的标准方法。网上版载有补充材料，可在10.1007/s00401-020-02255-2查阅。
Currently, the neuropathological diagnosis of Lewy body disease (LBD) may be stated according to several staging systems, which include the Braak Lewy body stages (Braak), the consensus criteria by McKeith and colleagues (McKeith), the modified McKeith system by Leverenz and colleagues (Leverenz), and the Unified Staging System by Beach and colleagues (Beach). All of these systems use semi-quantitative scoring (4- or 5-tier scales) of Lewy pathology (LP; i.e., Lewy bodies and Lewy neurites) in defined cortical and subcortical areas. While these systems are widely used, some suffer from low inter-rater reliability and/or an inability to unequivocally classify all cases with LP. To address these limitations, we devised a new system, the LP consensus criteria (LPC), which is based on the McKeith system, but applies a dichotomous approach for the scoring of LP (i.e., “absent” vs. “present”) and includes amygdala-predominant and olfactory-only stages. α-Synuclein-stained slides from brainstem, limbic system, neocortex, and olfactory bulb from a total of 34 cases with LP provided by the Newcastle Brain Tissue Resource (NBTR) and the University of Pennsylvania brain bank (UPBB) were scanned and assessed by 16 raters, who provided diagnostic categories for each case according to Braak, McKeith, Leverenz, Beach, and LPC systems. In addition, using LP scores available from neuropathological reports of LP cases from UPBB (n = 202) and NBTR (n = 134), JT (UPBB) and JA (NBTR) assigned categories according to all staging systems to these cases. McKeith, Leverenz, and LPC systems reached good (Krippendorff’s α ≈ 0.6), while both Braak and Beach systems had lower (Krippendorff’s α ≈ 0.4) inter-rater reliability, respectively. Using the LPC system, all cases could be unequivocally classified by the majority of raters, which was also seen for 97.1% when the Beach system was used. However, a considerable proportion of cases could not be classified when using Leverenz (11.8%), McKeith (26.5%), or Braak (29.4%) systems. The category of neocortical LP according to the LPC system was associated with a 5.9 OR (p < 0.0001) of dementia in the 134 NBTR cases and a 3.14 OR (p = 0.0001) in the 202 UPBB cases. We established that the LPC system has good reproducibility and allows classification of all cases into distinct categories. We expect that it will be reliable and useful in routine diagnostic practice and, therefore, suggest that it should be the standard future approach for the basic post-mortem evaluation of LP. The online version contains supplementary material available at 10.1007/s00401-020-02255-2.
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影响因子：
12.7
作者：
Tanei ZI;Saito Y;Ito S;Matsubara T;Motoda A;Yamazaki M;Sakashita Y;Kawakami I;Ikemura M;Tanaka S;Sengoku R;Arai T;Murayama S
通讯作者：
Murayama S
影响因子：
12.7
作者：
Doppler K;Ebert S;Uçeyler N;Trenkwalder C;Ebentheuer J;Volkmann J;Sommer C
通讯作者：
Sommer C
影响因子：
12.7
作者：
Toledo, Jon B.;Gopal, Pallavi;Trojanowski, John Q.
通讯作者：
Trojanowski, John Q.
影响因子：
6.4
作者：
Leverenz, James B.;Hamilton, Ronald;Montine, Thomas J.
通讯作者：
Montine, Thomas J.
DOI：
10.1097/nen.0b013e3180517454
发表时间：
2007-05-01
影响因子：
3.2
作者：
Fumimura, Yuichi;Ikemura, Masako;Murayama, Shigeo
通讯作者：
Murayama, Shigeo