在胃肠道病理学家中,在炎症性肠病中状上皮细胞变化的组织学评估中观察者间的变化:两种不同的定义的比较
Dorukhan Bahceci1, Rish K Pai2, Ian Brown3
1Department of Pathology, University of California at San Francisco, San Francisco, California, USA.
Histopathology
|July 24, 2025
概括
在炎症性肠病 (IBD) 中,对状上皮细胞变化 (SEC) 的两个定义进行了比较. 定义1 (DEF1) 在病理学家中显示出明显更高的可重现性,而不是定义2 (DEF2).
科学领域:
- 胃肠病学 胃肠病学
- 组织病理学 组织病理学
- 炎症性肠病 (IBD) 是一种炎症性肠病.
背景情况:
- 在炎症性肠病 (IBD) 中诊断状上皮细胞变化 (SEC) 的标准化组织学标准缺乏.
- 两种定义,DEF1 (更简单,需要内镜相关性) 和DEF2 (复杂的形态,没有内镜相关性),通常使用.
- 在胃肠道 (GI) 病理学家中使用这些定义的SEC诊断的可重复性尚未评估.
研究的目的:
- 用两个不同的定义来评估诊断炎症性肠病 (IBD) 中的状上皮细胞变化 (SEC) 的观察者间可重复性.
- 为了比较一个更简单的定义 (DEF1) 与一个更复杂的形态定义 (DEF2) 的诊断性能.
- 为了确定DEF1是否更有效地区分SEC与其他状病变,并模仿IBD.
主要方法:
- 七位胃肠道病理学家独立审查了38个胃肠道病例 (活检幻灯片和发布的图像),其中包括各种状变化和模仿.
- 使用DEF1 (最初是内镜正常,然后是结体/多重体) 和DEF2 (在相同的内镜假设下) 来评估病例.
- 使用Fleiss的kappa统计数据来衡量SEC诊断和其他类别 (HP,SSL,TSA,HMD,NSD) 的观察者间一致性.
主要成果:
- 与DEF2 (50/532) 相比,DEF1的结果是SEC诊断的数量 (110/532) 的两倍多.
- 对于SEC诊断的总体一致性在DEF1 (kappa=0.69) 中很大,但在DEF2 (kappa=0.18) 中很小.
- 使用DEF1.1,观察到实质性的一致性来诊断仿真症,如高塑性息肉 (HP),状状病变 (SSL),传统状腺瘤 (TSA),高肌性形 (HMD) 和没有状变化/形 (NSD).
结论:
- 使用DEF1诊断状上皮变化 (SEC) 在肠道病理学家中比使用DEF2显著更可复制.
- DEF1不太可能错过潜在的重要的SEC病例,并且提供了与其他状病变的更好区分,并在IBD中模仿.
- 建议采用DEF1来标准化IBD中的SEC诊断,提高诊断准确性和一致性.
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