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

Massimo Rugge, Diana Sacchi, Robert M. Genta, Francesca Zanco, Stefano Guzzinati, Marco Pizzi, Matteo Fassan, Antonio Di Sabatino, Hashem El-Serag

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
JournalDigestive and Liver Disease
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • Atrophic gastritis
  • Autoimmune gastritis
  • PPM
  • Pseudopyloric metaplasia
  • SPEM

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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