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Diagnosing Celiac Disease: Small Bowel Histopathology Results Can Vary Among Pathology Practices

Celiac.com 01/02/2012 - To properly diagnose celiac disease doctors must observe classic histological changes to small bowel mucosa. Success rates can vary among clinics and practitioners. A clinical team recently compared biopsy interpretation between different pathology practice types.

Photo: CC--MuffetA research team recently assessed variability in small bowel histopathology reporting between different pathology practice settings, and its impact celiac disease diagnosis.

The researchers included Carolina Arguelles-Grande, Christina A. Tennyson, Suzanne K. Lewis, Peter H. R. Green, and Govind Bhagat.

The team used a pathologist to blindly assessed biopsies from community hospitals (n=46), university hospitals (n=18) and commercial laboratories (n=38) for differences in histopathology reporting and agreement in diagnosis of celiac disease and degree of villous atrophy (VA) by k analysis.

Data showed very good agreement for primary diagnosis between the authors and university hospitals (k=0.888), but only moderate agreement compared with community hospitals (k=0.465) or commercial labs (k=0.419).

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The review showed that diagnosis varied in 26 (25%) cases, leading to a 20% increase in celiac disease diagnosis after review.

The 49 patients diagnosed with celiac disease by both institutions showed fair agreement in degree of VA (k=0.292), with moderate agreement between the authors and commercial laboratories (k=0.500) and fair agreement with university hospitals (k=0.290) or community hospitals (k=0.211).

In 27% of cases, the degree of VA was upgraded, while VA was downgraded in just 2% of cases. Data also showed poor agreement for Marsh score categories 1 and 2 (k<0.0316), with both missed at other centers, and just fair or moderate agreement for Marsh scores 3a and 3b.

They found that data on the degree of VA and intraepithelial lymphocytosis were lacking in 26% and 86% of reports, while non-quantifiable descriptors, such as ‘blunting’ or ‘marked atrophy’ were common.

The data show that community-based hospitals and commercial pathology labs are under-diagnosing celiac disease-related histological changes.

To combat variations in biopsy interpretation and reduce under-diagnosis of celiac disease, the team calls for greater celiac disease awareness and uniformity in small bowel biopsy reporting among pathologists.

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