Interobserver variation in histopathological assessment of Helicobacter pylori gastritis

Table 1 Histologic features evaluated on each slide and score scale

Histologic features	Score	Grading
Chronic inflammation	0, none	0, none
	1, < 10 cic*/HPF**	1-2-3, mild
	2, > 10 cic/HPF	4-5-6, moderate to marked
	3, some areas with dense cic
	4, diffuse infiltration with dens cic
	5, nearly whole mucosa contains a dense cic
	6, entire mucosa contains a dense cic infiltrate
Inflammatory activity	0, none	0, none
	1, only one crypt involved/biopsy	1-2, mild
	2, two crypts involved/biopsy	3-4-5-6, moderate to marked
	3, many crypts (< 25%) involved/biopsy
	4, 25%-50% of crypts involved/biopsy
	5, > 50% of crypts involved/biopsy
	6, all crypts involved
Atrophy	0, none	0, none
	1, foci where a few gastric glands are lost or replaced by ie●	1-2, mild
	2, small areas in which gastric glands	3-4-5-6, moderate to marked
	have disappeared or been replaced by ie
	3, < 25% of gastric glands lost or replaced by ie
	4, 25%-50% of gastric glands lost or replaced by ie
	5, > 50% of gastric glands lost or replaced by ie
	6, only a few small areas of gastric glands remaining
Intestinal metaplasia	0, none	0, none
	1, only one crypt replaced by ie	1-2-3, mild
	2, one focal area (1-4 crypts) in one of two biopsies	4-5-6, moderate to marked
	3, two separate foci
	4, multipl foci in one or both biopsies
	5, > 50% of gastric epithelium diffusely replaced by ie
	6, only a few small area of gastric epithelium are not replaced by ie
H pylori	0, none	0, none
	1, H pylori found only in one place	1-2-3-4, mild
	2, only a few H pylori found	5-6, moderate to marked
	3, scattered H pylori found in separate areas/foci
	4, numerous H pylori in separate areas/foci
	5, nearly complete gastric surface covered by a layer of H pylori
	6, continuous gastric surface coverage by a thick layer of H pylori
Surface epithelial damage	0, none	0, none
	1, slight	1-2-3-4, mild
	2, mild deg◆ in the top of the epithelial cells	5-6, moderate to marked
	3, moderate deg with disorientation of the epithelial lining
	4, indistinct cell borders at the surface of the epithelium
	5, flattened epithelial cells with severe deg and enlarged nuclei
	6, flattened to erosive epithelium of the entire surface

*: Chronic inflammatory cells, **: High power field, ●: Intestinal type epithelium, ◆: Degeneration.

Table 2 Kappa values and their 95% confidence intervals between three pathologists for H pylori gastritis

Variable	Pairwise analysis between pathologists
	1:2		1:3		2:3
	Kappa	95%CI	Kappa	95%CI	Kappa	95%CI
Chronic inflammation	0.49a	0.13-0.85	-0.34	NS	0.14	NS
Inflammatory activity	0.44a	0.13-0.71	-0.13	NS	-0.27	NS
Atrophy	0.31a	0.83-0.56	0.03	NS	0.14	NS
Intestinal metaplasia	0.51a	0.25-0.85	0.52a	0.20-0.80	0.62a	0.40-0.85
H pylori	0.40a	0.10-0.71	0.38a	0.06-0.71	0.56a	0.28-0.84
Surface epithelial damage	-0.01	NS	-	-	-	-

NS: Non-significant, 95%CI: 95% confidence interval, -: Kappa statistics could not be done because data table had less than two rows or columns;

^aP < 0.05.