Current recommendations for the analysis and reporting of gastric biopsies

Abstract

After carefully reading the article "Frequency of morphological changes in gastric biopsies associated with Helicobacter Pylori infection". It is medical knowledge that gastric cancer represents a frequent entity in our environment, worldwide it is the fifth most common cancer, also the third cause of mortality from cancer. In its global distribution, the presentation is more frequent in Eastern Asia, Eastern Europe, Central and South America; Unfortunately, diagnoses are not given early, which implies that the prognosis of patients is not favorable. (1)

Thanks to the continuous study of gastric cancer, it has been possible to establish its important association with inflammation and infection by Helicobacter pylori, multiple changes occur in the gastric mucosa prior to the development of cancer, which can include chronic superficial gastritis, atrophic gastritis , gastritis with the presence of lymphoid follicles or follicular gastritis, and intestinal metaplasia. Within the conclusions of their work, the authors comment that 42% of the pathological anatomy reports do not adjust to the parameters described internationally for the histological interpretation of morphological changes, this under the premise of variability among the pathologists who reviewed them. and recommend unifying concepts when preparing the report of histopathological findings. When reviewing the biopsy reporting system used in the study, it was confirmed that it was the Sydney protocol, which to date is known to have some difficulties in terms of interobserver reproducibility and that probably has an impact on the results. (2)

Currently, different international consensuses recommend the use of the OLGA/OLGIM protocol for reporting gastric biopsies. Due to its easy application and reproducibility, this system considers atrophy (loss of total glandular volume or its normal functionality due to pyloric metaplasia/ intestinal) as the lesion that indicates a real progression of gastritis, this is scored from 0 to IV, where 0 is no atrophy, I, minimal atrophy, and IV, the most severe degree of the same, its purpose is to stratify the risk of develop gastric cancer, in order to determine interventions, especially in those patients with OLGA III or IV score who will be monitored with endoscopy to detect GC early. (3)

In Colombia, this reporting system is already in use and its applicability has been demonstrated. In 2016, Martinez et al. analyzed a sample of more than 5,000 patients collected from 2010 to 2013. They showed that with the OLGA protocol, 61 .8% more cases of atrophy than using protocols with fewer biopsies (42% versus 26%), in addition, they confirmed the association of dysplasia with advanced stages of OLGA (III/IV), which is consistent with those reported in studies from other countries with high incidence of gastric cancer like Japan. (4)

For this reason, the community of gastroenterologists, endoscopists and pathologists are invited to establish working groups, where continuous updating is done on the most recent gastric cancer risk stratification protocols in order to offer a better diagnosis, treatment and follow-up of patients. ; with which an integral attention of the same ones is guaranteed.