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Autoimmune Metaplastic Atrophic Gastritis Reporting: Are Pathologists and Endoscopists on the Same Page?
Nicole Vienneau1, Hwajeong Lee1, Xulang Zhang1
1Department of Pathology and Laboratory Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY 12208, USA.
Diagnostics (Basel, Switzerland)
|November 27, 2025
Summary
Standardized protocols are needed for autoimmune metaplastic atrophic gastritis (AMAG) management due to inconsistent diagnostic and follow-up practices. This study found poor correlation between endoscopy and histology, highlighting the need for improved surveillance, especially for AMAG patients without neuroendocrine tumors (NET).
Area of Science:
- Gastroenterology
- Pathology
- Oncology
Background:
- Autoimmune metaplastic atrophic gastritis (AMAG) is a chronic autoimmune condition linked to increased cancer risk and nutritional deficiencies.
- Current diagnostic and follow-up procedures for AMAG are inconsistent and lack clarity, necessitating further investigation.
- This study specifically examines follow-up testing in AMAG patients, including those with neuroendocrine tumors (NET).
Purpose of the Study:
- To evaluate follow-up testing performance in patients diagnosed with AMAG and NET.
- To assess the correlation between endoscopic findings and histologic diagnoses in AMAG.
- To identify areas for improvement in the management and surveillance of AMAG.
Main Methods:
- Retrospective analysis of 65 gastric biopsies with potential AMAG diagnoses, including 12 with NET.
- Histologic review for atrophy, ECL cell hyperplasia, and Helicobacter; scoring of diagnostic comments and endoscopy reports.
- Collection of data on follow-up laboratory testing and biopsy performance from electronic medical records.
Main Results:
- No significant association was found between endoscopy scores and histology comment scores or atrophy grade.
- A higher histology comment score correlated with performing at least three laboratory tests (p=0.03).
- Follow-up biopsies were significantly more common in patients with NET compared to those with AMAG alone (p<0.001).
Conclusions:
- The observed poor correlation between endoscopic and histologic findings, along with variable follow-up practices, underscores the need for standardized AMAG management protocols.
- Improved adherence to biopsy guidelines, standardized pathology reporting, and consistent surveillance are crucial for better diagnosis and outcomes.
- Future research should focus on optimizing endoscopic techniques, standardizing serological tests, and developing evidence-based surveillance for AMAG patients.
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