title: Consensus diagnostic histopathological criteria for acute gastrointestinal graft versus host disease improve interobserver reproducibility.
abstract: Graft versus host disease (GvHD) is a clinically important complication after allogeneic hematopoietic stem cell transplantation (HSCT). Its diagnosis relies on clinical and histopathological findings. In order to evaluate and improve inter-institutional diagnostic agreement on histological diagnosis and grading of acute gastrointestinal GvHD, we conducted a round robin test, which included 33 biopsies from 23 patients after HSCT. Five pathologists from different institutions independently evaluated the original sections from the biopsies submitted for diagnosis. Based on their results, consensus qualitative criteria for the assessment of typical histological features of GvHD (e.g., apoptosis, crypt destruction, mucosa denudation) were proposed, including detailed descriptions as well as histological images. In a second round robin test with involvement of the same pathologists, the reproducibility of both diagnosis and grading had improved. Remaining differences were mostly related to differential diagnostic considerations, including viral infection or toxic side effects of medication, which should be resolved by integrating histopathological findings with proper clinical information.
authors.affiliation: Institute of Pathology, University Medical Center Mainz, Langenbeckstr. 1, 55101, Mainz, Germany, andreas.kreft@unimedizin-mainz.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kreft
authors.forename: Anja
authors.initials: A
authors.lastname: Mottok
authors.forename: Ildiko
authors.initials: I
authors.lastname: Mesteri
authors.forename: Diana M
authors.initials: DM
authors.lastname: Cardona
authors.forename: Anne
authors.initials: A
authors.lastname: Janin
authors.forename: Anja A
authors.initials: AA
authors.lastname: Kühl
authors.forename: Mindaugas
authors.initials: M
authors.lastname: Andrulis
authors.forename: Andrea
authors.initials: A
authors.lastname: Brunner
authors.forename: Howard M
authors.initials: HM
authors.lastname: Shulman
authors.forename: Giovanni
authors.initials: G
authors.lastname: Negri
authors.forename: Alexandar
authors.initials: A
authors.lastname: Tzankov
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Huber
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D032921:Consensus; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation