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. 2001 Jan;54(1):63-9.
doi: 10.1136/jcp.54.1.63.

Rapid quantitative assessment of gastric corpus atrophy in tissue sections

N C van Grieken  1 , M M Weiss, G A Meijer, E Bloemena, J Lindeman, G J Offerhaus, S G Meuwissen, J P Baak, E J Kuipers
Affiliations

Rapid quantitative assessment of gastric corpus atrophy in tissue sections

N C van Grieken et al. J Clin Pathol. 2001 Jan.

Abstract

Background/aims: Grading of Helicobacter pylori induced atrophic gastritis using the updated Sydney system is severely limited by high interobserver variability. The aim of this study was to set up a quantitative test of gastric corpus mucosal atrophy in tissue sections and test its reproducibility and correlation with the Sydney scores of atrophy.

Method: Mucosal atrophy was assessed in 124 haematoxylin and eosin stained corpus biopsy specimens by two experienced gastrointestinal pathologists (EB, JL) according to the updated Sydney system as none (n = 33), mild (n = 33), moderate (n = 33), or pronounced (n = 25). In each specimen, the proportions of glands, stroma, infiltrate, and intestinal metaplasia in the glandular zone were measured as volume percentages using a point counting method. The optimal point sample size, intra-observer and interobserver reproducibility, discriminative power for degrees of atrophy, and correlations with H pylori status were evaluated.

Results: Counting 400 points in 200 fields of vision provided the smallest sample size that still had excellent intra-observer and interobserver reproducibility (r > or = 0.96). Overall, the volume percentage of glands (VPGL), infiltrate (VPI), and stroma (VPS) correlated well with the Sydney scores for atrophy (p < or = 0.003). However, no differences were found between non-atrophic mucosa and mild atrophy. No correlation was found between age and either the Sydney grade of atrophy or the VPGL or VPS. In non-atrophic mucosa and mild atrophy, H pylori positive cases showed a significantly higher VPI than did H pylori negative cases. A lower VPGL was seen in H pylori positive cases than in H pylori negative cases in the mild atrophy group. VPS did not correlate with H pylori status within each grade of atrophy.

Conclusion: Point counting is a powerful and reproducible tool for the quantitative analysis of mucosal corpus atrophy in tissue sections. These data favour the combination of "none" and "mild" atrophy into one category, resulting in a three class grading system for corpus atrophy, when using the updated Sydney system.

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Figures

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Figure 1 The optimal sample size for measuring the volume percentage of glands (VPGL) in the glandular zone of the gastric mucosa was determined in tissue sections of seven corpus biopsy specimens. The VPGL was assessed by counting 100, 200, 400, 600, and 800 points in each tissue section. Counting 400 points appeared to be the smallest sample size that yielded optimal reproducibility.
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Figure 2 Interobserver agreement on the assessment of volume percentage of glands (VPGL; A), stroma (VPS; B), infiltrate (VPI; C), and intestinal metaplasia (VPIM; D) by means of point counting in the glandular zone of gastric corpus mucosa for 20 cases. Correlation coefficients (r) and p values are shown in the corresponding graphs. Intestinal metaplasia (D) was present in only four of 20 cases. The remaining 16 cases are illustrated in a sunflower presentation where each "leaf" represents a case.
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Figure 3 Volume percentages of glands (VPGL; A), stroma (VPS; B), infiltrate (VPI; C), and intestinal metaplasia (VPIM; D) for different degrees of corpus atrophy according to the updated Sydney system in 124 gastric corpus biopsies. In the moderate atrophy group only one case showed intestinal metasplasia (VPIM, 3.1%; mean VPIM, < 0.1). The Student's t test was used to calculate p values. Grade of atrophy: group 0, no atrophy; group 1, mild atrophy; group 2, moderate atrophy; group 3, pronounced atrophy.
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Figure 4 Mean cumulative volume percentages of glands, intestinal metaplasia, stroma and inflammatory cells (VPGL, VPIM, VPS, and VPI, respectively) for different degrees of corpus atrophy according to the updated Sydney system in 124 gastric corpus biopsies. In the moderate atrophy group only one case showed IM (VPIM, 3.1%; mean VPIM, < 0.1). Grade of atrophy: group 0, no atrophy; group 1, mild atrophy; group 2, moderate atrophy; group 3, pronounced atrophy.
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Figure 5 Volume percentage of glands (VPGL; A) and infiltrate (VPI; B) for different grades of atrophy according to the updated Sydney system in 124 gastric corpus biopsy specimens stratified by Helicobacter pylori (Hp) status. The Mann-Whitney U test was used to calculate the p values. Grade of atrophy: group 0, no atrophy; group 1, mild atrophy; group 2, moderate atrophy; group 3, pronounced atrophy. NS, not significant.
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Figure 6 Receiver operating characteristic (ROC) curves showing the sensitivity and specificity of different cut off values using the volume percentage of glands distinguishing (A) non-atrophic mucosa from low grade atrophy and (B) low grade from high grade atrophy
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