Interdisciplinary analysis of cues to triage gastric lymphoid proliferations: Role of the surgical pathologist revisited.

Surgical pathologists who examine gastric biopsies must triage exuberant lymphoid infiltrates for hematopathology consultation, a task that should account for resource and time utilization. We assembled all cases of chronic gastritis sent by surgical pathologists to hematopathology due to concern for low-grade lymphoma over a 4-year interval. The cases were ultimately classified as reactive (n = 37), atypical (n = 9), or lymphoma (n = 18). A surgical pathologist assessed lymphoid aggregates for their distribution and density, the presence of lymphoepithelial lesions, destruction of native structures, and monocytoid and/or centrocytoid and/or high grade cytology. Endoscopic findings, Helicobacter pylori infection, and any history of lymphoma were documented. Most reactive infiltrates displayed only one of the aforementioned concerning features, whereas atypical cases tended to have at least two and lymphomas at least 3 histologic hallmarks of lymphoma. Logistic regression analysis showed that history of lymphoma, and presence of >3 concerning histologic features were significantly associated with final classification of atypical or lymphoma. The presence of full thickness lymphoid infiltrates approached significance. Combination of these three features produced an area under a receiver operating characteristic (ROC) curve of 0.9, indicating excellent discrimination between reactive and atypical lymphoid infiltrates/lymphomas. We conclude that surgical pathologists can reliably triage gastric lymphoid infiltrates for consultation and ancillary studies by combining clinical data with evaluation of histologic features.