3 research outputs found
15-ЛЕТНИЙ ОПЫТ ПРИМЕНЕНИЯ ГИСТОПАТОЛОГИЧЕСКОЙ ШКАЛЫ И ДИАГНОСТИЧЕСКОГО АЛГОРИТМА СИНОВИТА: ОЦЕНКА И ДАЛЬНЕЙШЕЕ РАЗВИТИЕ
The diagnostic histopathology scales are mainly the multilevel evaluation systems. The same principle is lying in the basis of synovitis scale elaboration. This scale gradually and semi-quantitatively assesses the inflammatory and immunological changes in case of synovitis considering three synovial components: thickness of synovial cellular layer, cellular stroma density and severity of inflammatory infiltration. The scale comprises four semi-quantitative grades: normal 0, mild, moderate and severe. Scale points from 0 to 9 are summated. Such sum evaluation allows to identify high and low degree synovitis. Scale points from 1 to ≤4 correspond to low degree synovitis which determines and includes the following diagnosis: arthritis associated synovitis; synovitis associated with meniscus pathology; hemochromatosis associated synovitis. Scale points from ≥5 to 9 determine high degree synovitis including diagnosis like rheumatoid arthritis; psoriatic arthritis; Lyme arthritis; post infection (reactive) arthritis and peripheral arthritis in Bekhterev’s disease. Thus, the synovitis scale allows to assess degenerative or posttraumatic (low degree synovitis) and inflammatoryrheumatoid pathology (high degree synovitis) based on histopathological diagnostics with sensitivity of 61,7% and specificity of 96,1%. The scale is characterized by a good diagnostics significance by ROC analysis (area under curve: 0,8–0,9). Two versions of synovitis scale was published: first in 2002, second reworked in 2006 and the latter includes the concept of subdivision into two groups of high and low degree synovitis. Thanking to both versions a national and international recognition of histological evaluation during 15 years was gained. To clarity diagnosis description using synovitis scale particularly in rheumatology various inflammatory antigens were suggested for immunohistochemical analysis (including Ki-67, CD68-, CD3-, CD15и CD20). This immunohistochemical scale and subdivision into low and high degree synovitis provided a possibility to assess the risk of development and biological sensitivity of rheumatoid arthritis. Thus, an important histological input was made into primary rheumatology diagnostics which did not consider tissue changes. Due to formal integration of synovitis scale into the algorithm of synovial pathology diagnostics a comprehensive classification was developed specifically for differentiated orthopaedics diagnostics.Предложенная авторами шкала позволяет оценивать воспалительные и иммунологические изменения при синовите, учитывая три компонента: ширину синовиального клеточного слоя, клеточную плотность стромы и выраженность воспалительной инфильтрации. Шкала включает четыре полуколичественных степени: нормальную (0), легкую, среднюю и выраженную. Суммарное количество баллов, варьирующихся от 0 до 9, рассчитывается путем сложения, что позволяет выделить синовит высокой и низкой степени выраженности. значения шкалы синовита от 1 до ≤4 соответствуют синовиту низкой степени выраженности (артроз-ассоциированный синовит; посттравматический синовит; синовит, связанный с патологией менисков; гемохроматоз-ассоциированный синовит). При значениях шкалы от ≥5 до 9 выделяют синовит высокой степени выраженности (ревматоидный артрит, псориатический артрит, лайм-артрит, постинфекционный (реактивный) артрит и периферический артрит при болезни Бехтерева). Шкала позволяет на основании гистопатологической диагностики судить о дегенеративном или посттравматическом (синовит низкой степени выраженности) и воспалительно-ревматическом заболевании (синовит высокой степени выраженности) с чувствительностью 61,7% и специфичностью 96,1%. Благодаря интеграции шкалы синовита в алгоритм диагностики синовиальной патологии появилась комплексная классификация в дифференцированном контексте ортопедической диагностики
15 years of the histopathological synovitis score, further development and review: A diagnostic score for rheumatology and orthopaedics.
The histopathological synovitis score evaluates the immunological and inflammatory changes of synovitis in a graduated manner generally customary for diagnostic histopathological scores. The score results from semiquantitative evaluation of the width of the synovial surface cell layer, the cell density of the stroma and the density of the inflammatory infiltration into 4 semiquantitative levels (normal 0, mild 1, moderate 2, severe 3). The addition of these values results in a final score of 0-9 out of 9. On the basis of this summation the condition is divided into low-grade synovitis and high-grade synovitis: A synovitis score of 1 to≤4 is called low-grade synovitis (arthrosis-associated/OA synovitis, posttraumatic synovitis, meniscopathy-associated synovitis and synovitis with haemochromatosis). A synovitis score of≥5 to 9 is called high-grade synovitis (rheumatoid arthritis, psoriatic arthritis, Lyme arthritis, postinfection/reactive arthritis and peripheral arthritis with Bechterew's disease). By means of the synovitis score it is therefore possible to distinguish between degenerative/posttraumatic diseases (low-grade synovitis) and inflammatory rheumatic diseases (high-grade synovitis) with a sensitivity of 61.7% and a specificity of 96.1%. The diagnostic accuracy according to ROC analysis (AUC: 0.8-0.9) is good. Since the first publication (2002) and an associated subsequent publication (2006), the synovitis score has nationally and internationally been accepted for histopathological assessment of the synovitis. In a PubMed data analysis (status: 14.02.2017), the following citation rates according to Cited by PubMed Central articles resulted for the two synovitis score publications: For DOI: 10.1078/0344-0338-5710261 there were 29 Cited by PubMed Central articles and for the second extended publication DOI:10.1111/j.1365-2559.2006.02508 there were 44 Cited by PubMed Central articles. Therefore a total of 73 PubMed citations are observed over a period of 15 years, which demonstrates an international acceptance of the score. This synovitis score provides for the first time a diagnostic, standardised and reproducible histopathological evaluation method enabling a contribution to the differential diagnosis of chronic inflammatory general joint diseases. This is particularly the case by incorporation into the joint pathology algorithm. To specify the synovitis score an immunohistochemical determination of various inflammation-relevant CD antigens is proposed to enable a risk stratification of high-grade synovitis (e.g.: progression risk and sensitivity for biologicals)