Histological assessment of gastric pseudopyloric metaplasia: Intra- and inter-observer consistency. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Rugge, Massimo; Sacchi, Diana; Genta, Robert M.; Zanco, Francesca; Guzzinati, Stefano; Pizzi, Marco; Fassan, Matteo; Di Sabatino, Antonio; El-Serag, Hashem
• Is Part Of: Digestive and liver disease. Volume 53:Issue 1(2021)
• Page Start: 61
• Page End: 65
• Publication Date: 2021-01
• Subjects: Pseudopyloric metaplasia -- PPM -- SPEM -- Atrophic gastritis -- Autoimmune gastritis; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2020.09.003
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Background: The histological spectrum of oxyntic mucosal atrophy (a major determinant of gastric cancer risk) includes pseudopyloric metaplasia (PPM), which histological assessment has been regarded as unreliable. PPM consistently expresses Trefoil-Factor 2 (TFF2), which is histochemically detecteble (TFF2-IHC). Aims: Intra- and inter-observer consistency in assessing PPM was examined using both hematoxylin & eosin (H&E) and TFF2-IHC. Materials and methods: Seventy-four oxyntic biopsy samples obtained from autoimmune gastritis were considered. Two serial histological sections obtained from the paraffin-embedded tissue-samples were stained with H&E and TFF2-IHC. Three pathologists (Alpha, Beta, Gamma) independently scored PPM by both staining and the Intra- and inter-observer consistency (H&E versus TFF2-IHC) was calculated using k -statistics and/or Spearman's coefficient. Results: Based on H&E-stain versus TFF2-IHC, intra-observer consistency in PPM assessement was ranked as consistently "good" ( k -values: Alpha=0.79; Beta=0.78; Gamma=0.75). Based on H&E, the overall PPM inter-observer consistency among the 3 observers was ranked as "good" ( k =0.77) (the inter-observer consistency for pairs of observers was as follows: Alpha versus Beta k =0.88; Alpha versus Gamma k =0.87; Beta versus Gamma k =0.80). Based on TFF2-IHC, the overall PPM inter-observer agreement was ranked as "excellent" ( k =0.91) (the inter-observer consistency for pairs of observers was as follows: Alpha versus Beta k =1; Alpha versus Gamma k =0.91; Beta versus Gamma k =0.91). Conclusion: Relying on either H&E staining or TFF2-IHC, pathologists assess PPM consistently.