PT  - JOURNAL ARTICLE
AU  - Federico Biagi
AU  - Claudia Vattiato
AU  - Marco Burrone
AU  - Annalisa Schiepatti
AU  - Simona Agazzi
AU  - Gregorio Maiorano
AU  - Ombretta Luinetti
AU  - Costanza Alvisi
AU  - Catherine Klersy
AU  - Gino Roberto Corazza
TI  - Is a detailed grading of villous atrophy necessary for the diagnosis of enteropathy?
AID  - 10.1136/jclinpath-2016-203711
DP  - 2016 Dec 01
TA  - Journal of Clinical Pathology
PG  - 1051--1054
VI  - 69
IP  - 12
4099  - http://jcp.bmj.com/content/69/12/1051.short
4100  - http://jcp.bmj.com/content/69/12/1051.full
SO  - J Clin Pathol2016 Dec 01; 69
AB  - Aims The utility of the 7 level Marsh–Oberhuber classification of mucosal damage in patients with coeliac disease has recently been criticised. Analysis of duodenal biopsies with dissecting microscopy is an unsophisticated method that, however, provides useful information in cases of frank villous atrophy. In the last 15 years, we have always analysed duodenal biopsies with dissecting microscopy before sending them to the pathology department for histology. If the results of dissecting microscopy and traditional histology were comparable, we feel that would be strong evidence that grading of the histological lesion would be unnecessary if not pointless in the everyday diagnosis of enteropathies.Methods The clinical notes of all 2075 patients undergoing duodenal biopsy between September 1999 and June 2015 were retrospectively analysed. Results of duodenal mucosal evaluation with both dissecting microscopy and traditional histology were collected and statistically compared.Results The κ statistics showed a substantial agreement of the two methods (κ statistics 0.78). Sensitivity of dissecting microscopy for detection of severe villous atrophy was 85.1% (95% CI 81.2% to 88.5%) and specificity was 95% (95% CI 93.8% to 96%).Conclusions Although dissecting microscopy is an unsophisticated method that obviously cannot substitute traditional histology, our results suggest that in everyday clinical practice, the diagnosis of coeliac disease and other flat enteropathies does not require grading of villous atrophy.