title: Is a detailed grading of villous atrophy necessary for the diagnosis of enteropathy?
abstract: OBJECTIVE
  The utility of the 7 level Marsh-Oberhuber classification of mucosal damage in patients with coeliac disease has recently been criticised. Analysis of duodenal biopsies with dissecting microscopy is an unsophisticated method that, however, provides useful information in cases of frank villous atrophy. In the last 15 years, we have always analysed duodenal biopsies with dissecting microscopy before sending them to the pathology department for histology. If the results of dissecting microscopy and traditional histology were comparable, we feel that would be strong evidence that grading of the histological lesion would be unnecessary if not pointless in the everyday diagnosis of enteropathies.
  
  
  METHODS
  The clinical notes of all 2075 patients undergoing duodenal biopsy between September 1999 and June 2015 were retrospectively analysed. Results of duodenal mucosal evaluation with both dissecting microscopy and traditional histology were collected and statistically compared.
  
  
  RESULTS
  The κ statistics showed a substantial agreement of the two methods (κ statistics 0.78). Sensitivity of dissecting microscopy for detection of severe villous atrophy was 85.1% (95% CI 81.2% to 88.5%) and specificity was 95% (95% CI 93.8% to 96%).
  
  
  CONCLUSIONS
  Although dissecting microscopy is an unsophisticated method that obviously cannot substitute traditional histology, our results suggest that in everyday clinical practice, the diagnosis of coeliac disease and other flat enteropathies does not require grading of villous atrophy.
authors.affiliation: First Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Biagi
authors.affiliation: First Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Vattiato
authors.affiliation: Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Burrone
authors.affiliation: First Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Schiepatti
authors.affiliation: First Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Agazzi
authors.affiliation: First Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Maiorano
authors.affiliation: Department of Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Ombretta
authors.initials: O
authors.lastname: Luinetti
authors.affiliation: First Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Costanza
authors.initials: C
authors.lastname: Alvisi
authors.affiliation: Biometry and Statistics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.affiliation: First Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Gino Roberto
authors.initials: GR
authors.lastname: Corazza
mesh_terms: D000328:Adult; D001284:Atrophy / Q000145:classification / Q000175:diagnosis; D001706:Biopsy; D002446:Celiac Disease / Q000145:classification / Q000175:diagnosis*; D004386:Duodenum / Q000473:pathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D046888:Tissue Array Analysis
keywords: GASTROENTEROLOGY; GUT PATHOLOGY; SMALL INTESTINE