J Gastrointestin Liver Dis, December 2017 Vol. 26 No 4: 351-356 Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest, Romania Address for correspondence: Prof. Cristian Gheorghe, Gastroenterology and Hepatology Center, Fundeni Clinical Institute, 258 Fundeni Str, 022328 Bucharest, SE2, Romania drgheorghe@xnet.ro Received: 27.09.2017 Accepted: 20.11.2017 Te Orientation of Gastric Biopsy Samples Improves the Inter- observer Agreement of the OLGA Staging System Bogdan Cotruta, Cristian Gheorghe, Razvan Iacob, Mona Dumbrava, Cristina Radu, Ion Bancila, Gabriel Becheanu INTRODUCTION Gastric cancer is one of the most common cancers worldwide, being the third leading cause of cancer death in both genders [1, 2]. Te global incidence of gastric cancer has declined in the last few decades. However, in some regions, including Eastern Asia, South America, Eastern Europe, and ORIGINAL PAPER ABSTRACT Background & Aims: Evaluation of severity and extension of gastric atrophy and intestinal metaplasia is recommended to identify subjects with a high risk for gastric cancer. Te inter-observer agreement for the assessment of gastric atrophy is reported to be low. Te aim of the study was to evaluate the inter-observer agreement for the assessment of severity and extension of gastric atrophy using oriented and unoriented gastric biopsy samples. Furthermore, the quality of biopsy specimens in oriented and unoriented samples was analyzed. Methods: A total of 35 subjects with dyspeptic symptoms addressed for gastrointestinal endoscopy that agreed to enter the study were prospectively enrolled. Te OLGA/OLGIM gastric biopsies protocol was used. From each subject two sets of biopsies were obtained (four from the antrum, two oriented and two unoriented, two from the gastric incisure, one oriented and one unoriented, four from the gastric body, two oriented and two unoriented). Te orientation of the biopsy samples was completed using nitrocellulose flters (Endokit®, BioOptica, Milan, Italy). Te samples were blindly examined by two experienced pathologists. Inter-observer agreement was evaluated using kappa statistic for inter-rater agreement. Te quality of histopathology specimens taking into account the identifcation of lamina propria was analyzed in oriented vs. unoriented samples. Te samples with detectable lamina propria mucosae were defned as good quality specimens. Categorical data was analyzed using chi-square test and a two-sided p value <0.05 was considered statistically signifcant. Results: A total of 350 biopsy samples were analyzed (175 oriented / 175 unoriented). Te kappa index values for oriented/unoriented OLGA 0/I/II/III and IV stages have been 0.62/0.13, 0.70/0.20, 0.61/0.06, 0.62/0.46, and 0.77/0.50, respectively. For OLGIM 0/I/II/III stages the kappa index values for oriented/unoriented samples were 0.83/0.83, 0.88/0.89, 0.70/0.88 and 0.83/1, respectively. No case of OLGIM IV stage was found in the present case series. Good quality histopathology specimens were described in 95.43% of the oriented biopsy samples, and in 89.14% of the unoriented biopsy samples, respectively (p=0.0275). Conclusion: Te orientation of gastric biopsies specimens improves the inter-observer agreement for the assessment of gastric atrophy. . Key words: Gastric atrophy – nitrocellulose flters – gastric cancer – gastric biopsy. Abbreviations: H. pylori: Helicobacter pylori; OLGA: operative link for gastritis assessment; OLGIM: operative link on intestinal metaplasia assessment. Available from: http://www.jgld.ro/wp/archive/y2017/n4/a7/ DOI: http://dx.doi.org/10.15403/jgld.2014.1121.264.olg Portugal, the incidence rates are still high [1-3]. One of the major factors responsible for this could be the high prevalence of Helicobacter pylori (H. pylori) infection [4, 5]. H. pylori is considered to be the promoter of the cascade described by Correa [6], consisting of chronic infammation, mucosal atrophy, intestinal metaplasia, dysplasia, and cancer. The higher the extension and severity of gastric atrophy, the higher the risk of dysplasia and gastric cancer [7, 8]. For this reason, the current recommendation is to establish the extension and the severity of gastric atrophy using multiple biopsies standardized protocols [9]. A staging system using the severity and extension of gastric mucosal atrophy has been proposed