The British Journal of Rheumatology, Vol 37, 636-642, Copyright © 1998 by British Society for Rheumatology
B Bresnihan, G Cunnane, P Youssef, G Yanni, O Fitzgerald and D Mulherin
Previous studies have used various techniques for microscopic analysis of
rheumatoid synovium, ranging from rapid analysis of limited areas of tissue
to detailed quantification of extensive areas. The sensitivity and
reproducibility of these methods have not been tested. This study sought to
determine the minimum area of rheumatoid synovium needed to allow accurate
microscopic analysis of synovial inflammation. Multiple synovial tissue
samples were obtained from patients with rheumatoid arthritis at knee
arthroplasty (n = 10), knee arthroscopy (n = 10) and by blind needle biopsy
(n = 23). Lining layer thickness, sublining T- cell infiltration and
vascularity were measured in all high-power fields (hpf) throughout every
sample obtained from each patient. These complete measured results were
compared with estimated results from limited numbers of hpf from each
patient. It was observed that lining layer thickness estimated from as few
as five readings from 3 samples/patient correlated significantly with the
measured results obtained from as many as 85 readings/patient [Tau (T) =
0.70-0.94 for the three groups, all P < or = 0.005). Estimated measures
of T-cell infiltration and vascularity derived from only 17 randomly
selected hpf from 3 samples/patient (equivalent to 1 mm2) correlated
significantly with the measured results obtained from up to 150 hpf/patient
(T = 0.65- 0.94, all P < or = 0.002). Quantitative analysis of
inflammation in synovial tissue samples is both accurate and practical when
restricted to an evaluation of a limited number of microscopic fields. It
is proposed that lining layer thickness may be confidently quantified from
five randomly selected readings from three tissue samples, and that
sublining T-cell infiltration and vascularity may be quantified from 17
randomly selected hpf from the same samples.
ORIGINAL PAPERS
Microscopic measurement of synovial membrane inflammation in rheumatoid arthritis: proposals for the evaluation of tissue samples by quantitative analysis
Department of Rheumatology, University College Dublin, St Vincent's Hospital, Ireland.
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