HISTOPATHOLOGICAL SCALE AND SYNOVITIS ALGORITHM – 15 YEARS OF EXPERIENCE: EVALUATION AND FOLLOWING PROGRESS

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Abstract

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.

About the authors

V. Krenn

MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik

Email: fake@neicon.ru
Trier Germany

G. Perino

Hospital for Special Surgery

Email: fake@neicon.ru

Department of Pathology and Laboratory Medicine.

New York

United States

W. Rüther

Klinik und Poliklinik für Orthopädie, Universitätsklinikum Hamburg-Eppendorf

Email: fake@neicon.ru
Germany

V. T. Krenn

MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik

Author for correspondence.
Email: v.Krenn@patho-trier.de
Trier Germany

M. Huber

Pathologisch-bakteriologisches Institut, Otto Wagner Spital

Email: fake@neicon.ru
Wien Austria

T. Hügle

Hôpital Orthopédique

Email: fake@neicon.ru
Lausanne Switzerland

А. Najm

Rhumatologie, Centre hospital-universitaire de Nantes

Email: fake@neicon.ru
France

S. Müller

MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik

Email: fake@neicon.ru
Trier Germany

F. Boettner

Hospital for Special Surgery

Email: fake@neicon.ru

Department of Pathology and Laboratory Medicine

New York United States

F. Pessler

TWINCORE, Zentrum für Experimentelle und Klinische Infektionsforschung GmbH

Email: fake@neicon.ru
Hannover Germany

W. Waldstein

Medizinische Universität Wien, AKH-Wien, Universitätsklinik für Orthopädie

Email: fake@neicon.ru
Wien, Österreich Germany

J. Kriegsmann

MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik

Email: fake@neicon.ru
Trier Germany

T. Häupl

Med. Klinik, Rheumatologie und Klinische Immunologie (Charité)

Email: fake@neicon.ru
Berlin Germany

S. Wienert

VMscope

Email: fake@neicon.ru
Berlin Germany

M. G. Krukemeyer

Paracelsus-Kliniken Deutschland

Email: fake@neicon.ru
Osnabrück Germany

S. Sesselmann

Orthopädische Universitätsklinik Erlangen

Email: fake@neicon.ru
Erlangen Germany

R. M. Tikhilov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru
Saint Petersburg Russian Federation

L. Morawietz

Klinikum Ernst von Bergmann gemeinnützige GmbH Akademisches Lehrkrankenhaus der Humboldt-Universität Berlin (Charité)

Email: fake@neicon.ru
Берлин Germany

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