Original article—alimentary tract
Comparison of the Interobserver Reproducibility With Different Histologic Criteria Used in Celiac Disease

https://doi.org/10.1016/j.cgh.2007.03.019Get rights and content

Background & Aims: The Marsh–Oberhuber classification of duodenojejunal mucosal lesions is currently used for celiac disease. A more simplified classification, which is based on 3 villous morphologies (A, non-atrophic; B1, atrophic, villous-crypt ratio <3:1; B2, atrophic, villi no longer detectable) and an intraepithelial lymphocyte count of >25/100 enterocytes, has recently been proposed. The aim of the study was to asses the interobserver agreement between different pathologists in classifying celiac disease lesions according to both Marsh–Oberhuber and the new classification system. Methods: Sixty patients were selected for the study: 10 subjects without celiac disease, 13 celiac patients with normal villi but a pathologic increase in intraepithelial lymphocytes >25/100 and hyperplastic crypts, and 37 patients with celiac disease with villous atrophy. Sixty slides were sent to 6 pathologists, who were blinded to each other and were not given any clinical information. Each pathologist received the set of biopsy specimens on 2 separate occasions and had to evaluate them according to both grading systems in a random order. The kappa statistic was used to assess agreement between each pair of pathologists. Results: Overall, mean kappa values were 0.35 (fair) for the Marsh–Oberhuber classification versus 0.55 (moderate) for the new classification system. Conclusions: The new classification for duodenal pathology in celiac disease gives better interobserver agreement compared with the more cumbersome Marsh–Oberhuber classification and contributes to the validity of diagnosis in celiac disease.

Section snippets

Study Design and Case Selection

A panel of 60 slides of duodenal biopsy specimens were selected at the coordinating center by 2 pathologists (V.V. and C.Z.), who were responsible for the final diagnoses and for the appropriate quality of the biopsy specimens (these pathologists did not take part in the study). At least 4 biopsies were obtained from each patient from the second part of duodenum and properly positioned on millipore filters (Bio-Optica, Milan, Italy), because poor orientation is the major flaw in the histologic

Results

None of the pathologists taking part in the study notified the coordinating center of any concern as to the proper adequacy of the sections.

Discussion

CD is a gluten-dependent enteropathy characterized by high prevalence,15 increased morbidity,16 and increased mortality rate.17 This underlines the absolute need for a confident diagnosis, for which intestinal biopsy is still considered the gold standard. There is a wide consensus that a second biopsy, taken after gluten withdrawal and showing an unequivocal improvement of the duodenal histology, constitutes an essential confirmation.18, 19

However, the pathologic evaluation of CD is prone to

References (22)

  • L.M. Koran

    The reliability of clinical methods, data and judgments (first of two parts)

    N Engl J Med

    (1975)
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