Comparison of the interobserver reproducibility with different histologic criteria used in celiac disease.
OBJECTIVE
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.
Corazza
Gino Roberto
GR
First Department of Medicine, Fondazione Policlinico S. Matteo, University of Pavia, Pavia, Italy. gr.corazza@smatteo.pv.it
Villanacci
Vincenzo
V
Zambelli
Claudia
C
Milione
Massimo
M
Luinetti
Ombretta
O
Vindigni
Carla
C
Chioda
Caterina
C
Albarello
Luca
L
Bartolini
Daniela
D
Donato
Francesco
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D002446:Celiac Disease / Q000145:classification / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004386:Duodenum / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012720:Severity of Illness Index