Digital pathology quantifies immune cells in gastric biopsies with H. pylori infection

Researchers have used digital quantitative pathology to count T cells, B cells, and neutrophils in gastric biopsies, finding that neutrophilic infiltration and the presence of lymphoid follicles were the features most strongly associated with Helicobacter pylori infection. The study, published in Diagnostic Pathology as an open-access research article on 23 October 2026, analyzed 154 patients whose gastric biopsy specimens had been classified as either H. pylori-positive or H. pylori-negative.

H. pylori infection is a major driver of chronic gastritis and is strongly associated with the development of preneoplastic lesions and gastric cancer. The host immune response, including both activation and regulatory mechanisms, plays a critical role in disease progression and tissue damage, which is why characterizing the inflammatory cells present in infected mucosa has long been a goal of gastric pathology.

The objective of the study was to characterize the quantitative profile of T lymphocytes, B lymphocytes, and neutrophils in gastric biopsies with and without H. pylori infection using digital quantitative pathology. The work was designed as a cross-sectional analytical observational study, meaning it captured a snapshot of findings at a single time point rather than following patients over time.

Methodologically, the team performed dual immunohistochemistry for CD4/CD8, CD20, and MPO, with H. pylori immunohistochemistry used as part of the infection assessment. Whole-slide images were digitized and analyzed in QuPath for automated cell quantification. A multivariable logistic regression model was then applied with H. pylori status as the dependent variable, allowing the investigators to estimate which histological and cellular features were independently associated with infection.

Of the 154 patients included, 76 were H. pylori-positive. In the multivariable analysis, activity, defined as neutrophilic infiltration, showed the strongest association with infection, with an odds ratio of 28.5 (95% confidence interval: 11.1 to 73.5; p < 0.001). The presence of lymphoid follicles was also significantly associated with infection, with an odds ratio of 3.43 (95% confidence interval: 1.33 to 8.88; p = 0.011).

The B-cell findings were also notable. H. pylori-positive cases showed a higher proportion of diffuse CD20-positive B cells in the restricted non-aggregate analysis, at 64.54% compared with 29.79% in H. pylori-negative cases, a difference that was statistically significant at p < 0.001. This suggests that B-cell-associated changes in the gastric mucosa accompany infection, beyond the formation of organized lymphoid follicles.

By contrast, the T-cell compartment told a different story. The CD4:CD8 ratio was numerically higher in H. pylori-positive patients than in H. pylori-negative patients, with a median of 3.73 versus 3.16, but this difference was not statistically significant (p = 0.756). Similarly, the percentages of CD4-positive and CD8-positive cells did not differ significantly between the two groups.

The authors concluded that H. pylori infection was associated with increased neutrophilic infiltration and B-cell-associated changes. They noted that although the CD4:CD8 ratio was numerically higher in H. pylori-positive patients, the difference was not statistically significant, and that CD4-positive and CD8-positive cell percentages were also comparable between groups. In other words, the clearest quantitative signals in this dataset lay with the neutrophil and B-cell measures rather than with the T-cell subsets examined.

The study’s conclusion emphasizes that quantitative digital pathology provides an objective approach for characterizing inflammatory-cell populations in the gastric mucosa and may complement conventional histopathological assessment. Because the analysis was cross-sectional and based on a single cohort of 154 biopsy specimens, the reported odds ratios describe associations with infection status in this sample rather than causal effects, and the findings would need to be evaluated in other patient populations before broader generalization.

Readers should also note that the article is being shared early to provide faster access to peer-reviewed, accepted research; it is citable and carries a permanent DOI, but this version is subject to further edits and will be replaced automatically by the final Version of Record. Within those limits, the work illustrates how automated whole-slide image analysis in platforms such as QuPath can turn routine gastric biopsies into quantifiable immune-cell profiles, offering pathologists a reproducible numerical complement to the traditional visual grading of gastritis and H. pylori-associated inflammation.

Subject of Research: Quantitative digital pathology profiling of T cells, B cells, and neutrophils in gastric biopsies with and without Helicobacter pylori infection

Article Title: Quantitative pathology characterization of T cells, B cells, and neutrophils in gastric biopsies with Helicobacter pylori infection

Article References: Quintero, L. M., Caro-Barbosa, M. V., Romero-Fandiño, I. A., González-Coba, A., Mosquera-Zamudio, A., Polo, J. F., Sprockel, J., Gómez, A., Cordoba, M. L. M., & Parra-Medina, R. (2026). Quantitative pathology characterization of T cells, B cells, and neutrophils in gastric biopsies with Helicobacter pylori infection. Diagnostic Pathology. https://doi.org/10.1186/s13000-026-01865-w

Image Credits: AI Generated

DOI: 10.1186/s13000-026-01865-w

Keywords: Helicobacter pylori, gastritis, digital pathology, immunohistochemistry, neutrophils, B cells, T cells, QuPath, lymphoid follicles, gastric biopsies, cross-sectional study, Quantitative