Measurement variability and diagnostic sensitivity of gastric mucosal inflammatory cell morphometry

OBJECTIVE: To assess the variability and sensitivity of morphometric measur es of gastric mucosal lymphocyte and plasma cells to determine a systematic procedure for evaluating the density of these mononuclear inflammatory cel ls (MNC). STUDY DESIGN: Gastric biopsies of antrum (n =3), incisura angularis (n = 2) and corpus (n = 3) from two controls and three patients with Helicobacter pylori-related gastritis (antral, diffuse or multifocal gastritis) were con sidered. In each biopsy, three fields from each of three sections were sele cted. In each field, stromal area was obtained by subtracting gland area (G A) from total area, and MNC were counted. Results were expressed as MNC/tot al mm(2) and MNC/stromal mm(2). Correlations with GA, coefficients of varia tion (CV), discriminant power analysis and analysis of variance were perfor med. RESULTS: Correlations always existed between GA and MNC/total mm(2) and rar ely between GA and MNC/stromal mm(2). CV of MNC/stromal mm(2) were lower (1 8%) than those of MNC/total mm(2) (30%). High sensitivity (95.4%) and speci ficity (95.8%) were found for MNC/stromal mm(2) but not for MNC/total mm(2) . Differences in MNC/stromal mm2 existed in all subjects (P < .0001). Highl y significant differences in MNC/stromal mm(2) were also found between norm al and inflammatory states, gastric sites and sections. CONCLUSION: In contrast to MNC/total mm(2), MNC/stromal mm(2) is an unbiase d estimate of MNC density. The following sampling procedure is proposed: tw o biopsies from each gastric site, two sections from each biopsy and two mi croscopic fields from each section.