Reproducibility of the histological diagnosis of celiac disease
- 14 June 2011
- journal article
- Published by Taylor & Francis Ltd in Scandinavian Journal of Gastroenterology
- Vol. 46 (9), 1065-1073
- https://doi.org/10.3109/00365521.2011.589471
Abstract
Objective. A small intestinal biopsy is considered to be the gold standard for the diagnosis of celiac disease (CD). However, the assessment of small intestinal histology may vary between pathologists. Our aim was, therefore, to determine the interobserver variability in the histological diagnosis of CD. Material and methods. Biopsy specimens of 297 pediatric patients suspected of having CD were revised by a single experienced pathologist and compared to the original reports. Mucosal changes were scored using the Marsh classification. In patients with a discrepancy in diagnosis, clinical and serological data were used to determine the most probable diagnosis. Results. Although the interobserver variability for the Marsh classification was found to be moderate with a Kappa value of 0.486, the Kappa value for the diagnosis reached an almost perfect agreement (0.850). Nevertheless, in 22 patients a different diagnosis was made by the second observer. Interestingly, in this subgroup relatively more biopsies were classified to be of suboptimal quality. Based on clinical presentation, serology and follow-up, 19 of those patients truly had CD. In 14 of them the diagnosis was originally missed by the first observer while five cases were under-diagnosed by the second pathologist. Conclusions. CD can be missed histologically due to assessment variation between pathologists. A final diagnosis of CD should be based on histology, serology as well as response to the diet.Keywords
This publication has 32 references indexed in Scilit:
- Celiac Disease Diagnosis: Simple Rules Are Better Than Complicated AlgorithmsThe American Journal of Medicine, 2010
- Assessment of the Diagnostic Value of Duodenal Bulb Histology in Patients With Celiac Disease, Using Multiple Biopsy SitesJournal of Clinical Gastroenterology, 2009
- The Absence of a Mucosal Lesion on Standard Histological Examination Does Not Exclude Diagnosis of Celiac DiseaseDigestive Diseases and Sciences, 2007
- Diagnostic significance of HLA‐DQ typing in patients with previous coeliac disease diagnosis based on histology aloneAlimentary Pharmacology & Therapeutics, 2006
- A National Prospective Study on Childhood Celiac Disease in the Netherlands 1993–2000: An Increasing Recognition and a Changing Clinical PictureThe Journal of Pediatrics, 2005
- Duodenal intraepithelial lymphocyte‐count revisitedScandinavian Journal of Gastroenterology, 2004
- Diagnosis of gluten-sensitive enteropathyEuropean Journal of Gastroenterology & Hepatology, 1998
- The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school‐age subjectsActa Paediatrica, 1996
- Coeliac disease in the year 2000: exploring the icebergThe Lancet, 1994
- Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition.Archives of Disease in Childhood, 1990