Biopsy Protocol

To obtain adequately representative samples for the classification of gastritis, the biopsy protocol is recommended. Biopsy specimens from the three compartments (antrum, incisuraangularis, and corpus) should be separately identifiable when they are submitted to the laboratory. Proper orientation is indispensable for optimal histological evaluation; it may be accomplished either in the endoscopy suite when biopsy specimens are collected, or in the histopathology laboratory at the time of embedding. This latter option is generally preferable, unless endoscopy personnel are experienced and motivated to perform the precise and tedious work required to orientate minuscule fragments of fresh tissue properly.

To translate histopathological observations into well-defined topographic patterns, each feature is then graded using the standardized Visual Analogue Scale. The final diagnosis issued should synthesize all individual evaluations, for example, “H.pyloriantrum-predominant gastritis” or “corpus-restricted atrophic gastritis without H.pylori infection, suggestive of autoimmune gastritis.”

The Updated Sydney System is also suitable for evaluating and diagnosing the special types of gastritis. A sample diagnosis might read “lymphocytic gastritis, corpus predominant, with H.pylori infection.” In the case of gastropathies, the Updated Sydney System is mainly useful for helping in the orderly assessment of the histopathological features of the mucosa. This applies even in the unlikely situation that the system’s recommended set of five biopsy specimens is obtained from a patient with portal hypertension or watermelon stomach. However, in most such cases, attempting to grade each specimen individually is neither recommended nor necessary.

Chronic gastritis and Helicobacter pylori organisms.A. H&E stain of gastric mucosa showing surface foveolar cells, adherent mucus, and scattered bacillary forms within the mucus. B. Steiner silver stain of superficial gastric mucosa, showing abundant darkly staining microorganisms layered over the apical portion of the surface epithelium. Note that there is no tissue invasion

Дата добавления: 2015-11-14