A novel method of grading gastric intestinal metaplasia based on the combination of subtype and distribution

Abstract

Background Studies have shown the value of subtypes and distribution of gastric intestinal metaplasia (GIM) for prediction of gastric cancer. We aim to combine GIM subtypes and distribution to form a new scoring system for GIM. Methods This was a cross-sectional study. No GIM, type I, II, and III GIM of gastric antrum and corpus scored 0–3 points respectively. Then the severity of the whole stomach was calculated in two ways: 1. The gastric antrum and corpus scores were added together, with a score ranging from 0 to 6, which named “Subtype Distribution Score of Gastric Intestinal Metaplasia (SDSGIM)”. 2. Direct classification according to a table corresponding to that of OLGIM. We compared the SDSGIM among benign lesions, dysplasia, and cancer and drew receiver operating characteristic (ROC) curve to determine the optimal cut-off value. According to the cut-off value and the classification from the table, the predictive ability of these two methods were calculated. Results 227 patients were included. For SDSGIM, benign lesion group was significantly different from dysplasia or cancer group. Area under curve of ROC curve was 0.889 ± 0.023. The optimal cut-off value was 3. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SDSGIM for malignancy were 89.5%, 78.0%, 74.6%, 91.2% and 82.8%. And those for the second classification method were 84.2%, 82.6%, 77.7%, 87.9%, and 83.3% respectively. Conclusions This study firstly combined GIM subtypes with its distribution forming a novel scoring system, which showed high prediction accuracy for malignant lesions.

Chronic Autoimmune Gastritis: Modern Diagnostic Principles

“…The modified OLGIM system (Operative Link on Gastric Intestinal Metaplasia Assessment), being more reproducible, offers only an assessment of the intestinal metaplasia presence as the main indicator of chronic gastritis stage [52,53]. Although the question of comparing these classifications from the sensitivity point remains controversial, since the use of OLGIM, which is more reproducible in practical application, may underestimate the true severity of absolute (non-metaplastic) atrophy [54][55][56].…”

History of chronic gastritis: How our perceptions have changed

“…The question of comparing these classifications from the point of view of sensitivity is still debatable, since the OLGIM, which is more reproducible in practical application, may underestimate the true severity of absolute (nonmetaplastic) atrophy[ 65 ]. Modifications of these classifications are based on similar principles of integral assessment[ 66 ].…”

Modern aspects of Helicobacter pylori infection

“…Для этого широко используют системы постановки диагноза, основанные на биопсии: «Оперативное звено для оценки гастрита» (Operative Link on Gastritis Assessment -OLGA) и «Оперативное звено для оценки метаплазии желудка и кишечника» (Ope rative Link on Gastric Intestinal Metaplasia -OLGIM). Разработана также система определения стадий OLGIM для всесторонней оценки и оценки тяжести гастроинтестинальной малигнизации (Gastric Intestinal Metaplasia -GIM) [41]. В соответствии с долей клеток кишечной метаплазии под микроскопом степень тяжести GIM антрального отдела желудка (не менее 3 биопсий) и тела желудка (не менее 2 биопсий) распределяют на 4 уровня (отсутствует, лёгкая, умеренная, тяжёлая), затем интегрируют тяжесть GIM антрального отдела и тела желудка и стратифицируют GIM в соответствии с таблицей классификации OLGIM [42].…”