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

V. Krenn; Кренн В.; G. Perino; Перино Г.; W. Rüther; Рютхер Щ.; V. T. Krenn; Кренн В. Т.; M. Huber; Хубер М.; T. Hügle; Хюгле Т.; А. Najm; Найм А.; S. Müller; Мюллер С.; F. Boettner; Боеттнер Ф.; F. Pessler; Песслер Ф.; W. Waldstein; Уалдштейн У.; J. Kriegsmann; Крейгсманн Й.; T. Häupl; Хэупл Т.; S. Wienert; Уиенерт С.; M. G. Krukemeyer; Крукемейер М. Г.; S. Sesselmann; Сесселманн С.; R. M. Tikhilov; Тихилов Р. М.; L. Morawietz; Моравец Л.

doi:10.21823/2311-2905-2017-23-2-39-48

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

Authors: Krenn V.¹, Perino G.², Rüther W.³, Krenn V.T.¹, Huber M.⁴, Hügle T.⁵, Najm А.⁶, Müller S.¹, Boettner F.², Pessler F.⁷, Waldstein W.⁸, Kriegsmann J.¹, Häupl T.⁹, Wienert S.¹⁰, Krukemeyer M.G.¹¹, Sesselmann S.¹², Tikhilov R.M.¹³, Morawietz L.¹⁴
Affiliations:
1. MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik
2. Hospital for Special Surgery
3. Klinik und Poliklinik für Orthopädie, Universitätsklinikum Hamburg-Eppendorf
4. Pathologisch-bakteriologisches Institut, Otto Wagner Spital
5. Hôpital Orthopédique
6. Rhumatologie, Centre hospital-universitaire de Nantes
7. TWINCORE, Zentrum für Experimentelle und Klinische Infektionsforschung GmbH
8. Medizinische Universität Wien, AKH-Wien, Universitätsklinik für Orthopädie
9. Med. Klinik, Rheumatologie und Klinische Immunologie (Charité)
10. VMscope
11. Paracelsus-Kliniken Deutschland
12. Orthopädische Universitätsklinik Erlangen
13. Vreden Russian Research Institute of Traumatology and Orthopedics
14. Klinikum Ernst von Bergmann gemeinnützige GmbH Akademisches Lehrkrankenhaus der Humboldt-Universität Berlin (Charité)
Issue: Vol 23, No 2 (2017)
Pages: 39-48
Section: METHODS OF EXAMINATIONS
Submitted: 01.07.2017
Accepted: 01.07.2017
Published: 30.06.2017
URL: https://journal.rniito.org/jour/article/view/724
DOI: https://doi.org/10.21823/2311-2905-2017-23-2-39-48
ID: 724

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Full Text

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.

Keywords

synovitis, synovitis scale, rheumatology arthritis, semi-quantitative evaluation, immunohistochemistry, risk stratification

About the authors

V. Krenn

MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik

Email: fake@neicon.ru
Trier Германия

G. Perino

Hospital for Special Surgery

Email: fake@neicon.ru

Department of Pathology and Laboratory Medicine.

New York

США

Department of Pathology and Laboratory Medicine

New York США

References

Badot V., Galant C., Nzeusseu Toukap A., Theate I., Maudoux A.L., Van Den Eynde B.J., Durez P., Houssiau F.A., Lauwerys B.R. Gene expression profiling in the synovium identifies a predictive signature of absence of response to adalimumab therapy in rheumatoid arthritis. Arthritis Res Ther. 2009;11(2):R57. doi: 10.1186/ar2678.
Fink B., Berger I., Siegmüller C., Siegmüller C., Fassbender H.G., Meyer-Scholten C., Tillmann K., Rüther W. Recurring synovitis as a possible reason for aseptic loosening of knee endoprostheses in patients with rheumatoid arthritis. J Bone Joint Surg Br. 2001;83(4):604-608.
Hügle T., Gashi G., Wiewiorski M., Müller-Gerbl М., Valderrabano V., Nowakowski A.M. Development of a New Device for Synovial Biopsies. Surg Innov. 2015;22(5): 496-499. doi: 10.1177/1553350614549634.
Jakobs M., Morawietz L., Rothschenk H., Rothschenk H., Hopf T., Weiner S., Schausten H., Krukemeyer M.G., Krenn V. [Synovitis score: value of histopathological diagnostics in unclear arthritis. Case reports from rheumatological pathological practice]. Z Rheumatol. 2007;66(8):706-712. (in german).
Kölbel B., Wienert S., Dimitriadis J., Kendoff D., Gehrke T., Huber M., Frommelt L., Tiemann A., Saeger K., Krenn V. [CD15 focus score for diagnostics of periprosthetic joint infections : Neutrophilic granulocytes quantification mode and the development of morphometric software (CD15 quantifier)]. Z Rheumatol. 2015;74(7):622-630. (in german). doi: 10.1007/s00393-015-1571-8.
Krenn V., Morawietz L., Häupl T., Neidel J., Petersen I., König A. Grading of chronic synovitisa histopathological grading system for molecular and diagnostic pathology. Pathol Res Pract. 2002;198(5):317-325.
Krenn V., Morawietz L., Burmester G.R., Burmester G.R., Kinne R.W., Mueller-Ladner U., Muller B., Häupl T. Synovitis score: discrimination between chronic low-grade and high-grade synovitis. Histopathology. 2006;49(4):358-364.
Krenn V., Morawietz L., König A., Häupl T. Differential diagnosis of chronic synovitis]. Pathologe. 2006;27(6): 402-408. (in german).
Krenn V., Morawietz L., Jakobs M., Kienapfel H., Ascherl R., Bause L., Kuhn H., Matziolis G., Skutek M., Gehrke T. [Joint endoprosthesis pathology. Histopathological diagnostics and classification]. Pathologe. 2011;32(3): 210-219. (in german). doi: 10.1007/s00292-011-1418-2.
Kriegsmann J, Kriegsmann M, Casadonte R. MALDI TOF imaging mass spectrometry in clinical pathology: a valuable tool for cancer diagnostics (review). Int J Oncol. 2015;46(3):893-906. doi: 10.3892/ijo.2014.2788.
Morawietz L, Krenn V. [The spectrum of histomorphological findings related to joint endoprosthetics]. Pathologe. 2014;35(2):218-224. (in german). doi: 10.1007/s00292-014-1976-1.
Pessler F., Dai L., Diaz-Torne C., Gomez-Vaquero C., Paessler M.E., Zheng D.H., Einhorn E., Range U., Scanzello C., Schumacher H.R. The synovitis of «non-inflammatory» orthopaedic arthropathies: a quantitative histological and immunohistochemical analysis. Ann Rheum Dis. 2008;67(8):1184-1187. doi: 10.1136/ard.2008.087775.
Pessler F., Ogdie A., Diaz-Torne C., Dai L., Yu X., Einhorn E., Gay S., Schumacher H.R. Subintimal Ki-67 as a synovial tissue biomarker for inflammatory arthropathies. Ann Rheum Dis. 2008;67(2):162-167.
Slansky E., Li J., Häupl T., Morawietz L., Krenn V., Pessler F. Quantitative determination of the diagnostic accuracy of the synovitis score and its components. Histopathology. 2010;57(3):436-443. doi: 10.1111/j.1365-2559.2010.03641.x.
Smolen J.S., Breedveld F.C., Burmester G.R., Bykerk V., Dougados M., Emery P., Kvien T.K., Navarro-Compán M.V., Oliver S., Schoels M., Scholte-Voshaar M., Stamm T., Stoffer M., Takeuchi T., Aletaha D., Andreu J.L., Aringer M., Bergman M., Betteridge N., Bijlsma H., Burkhardt H., Cardiel M., Combe B., Durez P., Fonseca J.E., Gibofsky A., Gomez-Reino J.J., Graninger W., Hannonen P., Haraoui B., Kouloumas M., Landewe R., Martin-Mola E., Nash P., Ostergaard M., Östör A., Richards P., Sokka-Isler T., Thorne C., Tzioufas A.G., Van Vollenhoven R., De Wit M., Van Der Heijde D. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2016 ;75(1):3-15. doi: 10.1136/annrheumdis-2015-207524.
Söder S., Aigner T. Osteoarthritis. [Etiology, typing, staging and histological grading]. Pathologe. 2011;32(3):183-192. doi: 10.1007/s00292-011-1419-1. (in german).
Sweeney S.E., Firestein g.S. Rheumatoid arthritis: regulation of synovial inflammation. Int J Biochem Cell Biol. 2004;36(3):372-378.
Ungethuem U., Haeupl T., Witt H., Koczan D., Krenn V., Huber H., Von Helversen T.M., Drungowski M., Seyfert C., Zacher J., Pruss A., Neidel J., Lehrach H., Thiesen H.J., Ruiz P., Bläss S. Molecular signatures and new candidates to target the pathogenesis of rheumatoid arthritis. Physiol Genomics. 2010;42A(4):267-282. doi: 10.1152/physiolgenomics.00004.2010.
van der Linden M.P., Knevel R., Huizinga T.w., van der Helm-van Mil A.H. Classification of rheumatoid arthritis: comparison of the 1987 American College of Rheumatology criteria and the 2010 American College of Rheumatology/ European League Against Rheumatism criteria. Arthritis Rheum. 2011;63(1):37-42. doi: 10.1002/art.30100.
van de Sande M.G., Baeten D.L. Immunopathology of synovitis: from histology to molecular pathways. Rheumatology (Oxford). 2016;55(4):599-606. doi: 10.1093/rheumatology/kev330.
Waldstein W., Perino G., Jawetz S.T., Gilbert S.L., Boettner F. Does intraarticular inflammation predict biomechanical cartilage properties? Clin Orthop Relat Res. 2014;472(7):2177-2184. doi: 10.1007/s11999-014-3583-0.
Zustin J., Aigner T. [Osteoarthritis--histopathologic diagnosis: typing, grading, and staging]. Orthopade. 2009;38(6):491-500. (in german). doi: 10.1007/s00132-008-1399-x.

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