Page 114 - Helicobacter pylori and Gastric Cancer: From Tumor microenvironment to Immunotherapy
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   Pepsinogen I/II ratio
   5.4 ± 1.8
     <5
       0.471
     Endoscopic atrophy
   No atrophy
   50 (40.3)
   67 (54.0)
  117 (47.2)
       0.00
      Antral (C-1)
   43 (34.7)
   36 (29.2)
  79 (31.9)
  Antral predominant (C-2)
   26 (20.9)
   0 (0.0)
  48 (19.4)
  Corpus predominant (C-3-O-2)
   5 (4.03)
     21 (17.0)
   26 (10.5)
    Histological atrophy
     None
   50 (40.3)
   57 (46.0)
  107 (43.1)
     0.00
      Antrum
   38 (30.2)
   41 (33.0)
  79 (31.8)
  Angulus
   20 (16.13)
   26 (20.5)
  46 (18.5)
  Lesser curvature of middle body
   16 (12.9)
   0 (00.0)
  16 (6.5)
  Greater curvature of middle body
   0 (0.0)
   0 (00.0)
  0 (0.0)
  Intestinal Metaplasia
   85 (68.5)
   63 (50.8)
  148 (59.7)
     0.06
       Complete subtype
   46 (37.1)
   32 (25.8)
  78 (31.4)
  Incomplete subtype
   30 (24.2)
   26 (20.9)
  56 (22.5)
  Unidentified
   9 (7.2)
   5 (4.1)
  14 (5.6)
Agreement between endoscopic and histological atrophy
The comparisons between endoscopic and histological atrophy scores are shown in table 2. Taking the study population in toto, of the 248 patients, 138 (55.0%) showed complete agreement between endoscopic assessment and final histological diagnosis. Importantly, the strength of agreement between the modified Kimura– Takemoto classification and histological atrophy, as defined by the updated Sydney system, showed good reproducibility, with a weighted kappa value of 0.89 [95% confidence interval (CI) 0.68–0.96]. However, a total of 110 patients were endoscopically misdiagnosed, including 45 (18.14%) who were over-diagnosed and 65 (26.2%) who were under-diagnosed. Of the 43 patients histologically diagnosed with atrophy in the middle of the body of the greater curvature, 21 (49 %) were under-diagnosed endoscopically. Moreover, 30 of 110 (127.3%) patients without histological atrophy were endoscopically over-diagnosed with antral or antral predominated atrophy. Thus generally speaking endoscopic assessment performs well but is not sufficient for accurate diagnosis
                                Chapter 5
Chapter 5
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