Histological assessment of gastric pseudopyloric metaplasia: Intra- and inter-observer consistency.

Rugge M, Sacchi D, Genta RM, Zanco F, Guzzinati S, Pizzi M, Fassan M, Di Sabatino A, El-Serag H. Histological assessment of gastric pseudopyloric metaplasia: Intra- and inter-observer consistency. Digestive and Liver Disease : Official Journal of The Italian Society of Gastroenterology and The Italian Association For The Study of The Liver. 2021 Jan 1; 53(1):61-65.

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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 and eosin (HandE) 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 HandE and TFF2-IHC. Three pathologists (Alpha, Beta, Gamma) independently scored PPM by both staining and the Intra- and inter-observer consistency (HandE versus TFF2-IHC) was calculated using k-statistics and/or Spearman''s coefficient. RESULTS: Based on HandE-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 HandE, 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 HandE staining or TFF2-IHC, pathologists assess PPM consistently.