title: Effect of tissue processing on assessment of endoscopic intestinal biopsies in dogs and cats.
abstract: BACKGROUND
  Prior studies failed to detect significant association between hypoalbuminemia and small intestinal lesions.
  
  
  OBJECTIVE
  Use of pictorial templates will enhance consistency of interpathologist interpretation and identification of intestinal lesions associated with hypoalbuminemia.
  
  
  METHODS
  Tissues from 62 dogs and 25 cats examined as clinical cases at 7 referral veterinary practices in 4 countries.
  
  
  METHODS
  Retrospective, observational study. Histopathology slides from sequential cases undergoing endoscopic biopsy were examined by 4 pathologists by pictorial templates. Changes for 9 microscopic features were recorded as normal, mild, moderate or severe, and 2- and 4-point scales were tested for consistency of interpretation. Logistic regression models determined odds ratios (OR) of histologic lesions being associated with hypoalbuminemia while kappa statistics determined agreement between pathologists on histologic lesions.
  
  
  RESULTS
  There was poor agreement (kappa = -0.013 to 0.3) between pathologists, and institution of origin of slides had effect (kappa = 1.0 for 3 of 4 lesions on slides from Institution 5) on agreement between pathologists on selected histologic features. Using 2 point as opposed to 4-point grading scale increased agreement between pathologists (maximum kappa = 0.69 using 4-point scale versus maximum kappa = 1.0 using 2-point scale). Significant association (P = .019- .04; 95% OR = 3.14-10.84) between lacteal dilation and hypoalbuminemia was found by 3 pathologists.
  
  
  CONCLUSIONS
  Substantial inconsistency between pathologists remains despite use of pictorial template because of differences in slide processing. Distinguishing between mild and moderate lesions might be important source of the disagreement among pathologists.
authors.affiliation: Department of Small Animal Clinical Sciences, College of Veterinary Medicine, TAMU-4474, Texas A&M University, College Station, TX 77843-4474, USA. mwillard@cvm.tamu.edu
authors.forename: M D
authors.initials: MD
authors.lastname: Willard
authors.forename: G E
authors.initials: GE
authors.lastname: Moore
authors.forename: B D
authors.initials: BD
authors.lastname: Denton
authors.forename: M J
authors.initials: MJ
authors.lastname: Day
authors.forename: J
authors.initials: J
authors.lastname: Mansell
authors.forename: T
authors.initials: T
authors.lastname: Bilzer
authors.forename: B
authors.initials: B
authors.lastname: Wilcock
authors.forename: M
authors.initials: M
authors.lastname: Gualtieri
authors.forename: D
authors.initials: D
authors.lastname: Olivero
authors.forename: P
authors.initials: P
authors.lastname: Lecoindre
authors.forename: D C
authors.initials: DC
authors.lastname: Twedt
authors.forename: M G
authors.initials: MG
authors.lastname: Collett
authors.forename: E J
authors.initials: EJ
authors.lastname: Hall
authors.forename: A E
authors.initials: AE
authors.lastname: Jergens
authors.forename: J W
authors.initials: JW
authors.lastname: Simpson
authors.forename: R W
authors.initials: RW
authors.lastname: Else
authors.forename: R J
authors.initials: RJ
authors.lastname: Washabau
mesh_terms: D000818:Animals; D001706:Biopsy / Q000662:veterinary*; D002371:Cat Diseases / Q000175:diagnosis / Q000473:pathology*; D002415:Cats; D004283:Dog Diseases / Q000175:diagnosis / Q000473:pathology*; D004285:Dogs; D004724:Endoscopy / Q000662:veterinary*; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000473:pathology / Q000662:veterinary*; D013048:Specimen Handling / Q000662:veterinary*