The diagnostic yield of individual gastric biopsies and the adherence to the Sydney System guidelines in the United States are unknown.
Dr Genta and Lash from Texas, USA evaluated the yield of different gastric sampling strategies and determine the adherence to the Sydney System guidelines in a nationwide sample of endoscopists.
Using a database of biopsy records diagnosed at a single pathology laboratory, the team analyzed the results of gastric biopsies taken to evaluate gastric inflammatory conditions in patients with no endoscopic lesions.
The research team then stratified the specimens by site of origin and number of mucosal fragments.
|66% of biopsies were submitted as antrum|
|Alimentary Pharmacology & Therapeutics|
The team calculated the relationship between number and origin of biopsy specimens, and detection of Helicobacter pylori and intestinal metaplasia.
Of 400,738 biopsy sets, 66% were submitted as antrum, 17% as corpus, 3% as cardia, and 25% without topographic identifiers.
Separate containers with at least 2 antral, and 2 corpus specimens were available in 15,645 cases.
For antrum, corpus, and unspecified sites, each additional tissue fragment was associated with an incremental increase in the yield for both H. pylori and intestinal metaplasia.
Sydney System-compliant sets had significantly greater yield than most of the unspecified or single-site sets.
The research team found that incisura angularis, rarely sampled, yielded minimal additional diagnostic information.
Dr Genta and colleague conclude, "In the absence of lesions, the acquisition of at least two biopsy specimens from antrum and corpus, essentially following the Sydney System recommendations, is a sensible strategy that guarantees the maximum diagnostic yield for the most common gastric inflammatory conditions."