Comparison of the interobserver reproducibility with different histologic criteria used in celiac disease
Comparison of the interobserver reproducibility with different histologic criteria used in celiac disease
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DOI：
10.1016/j.cgh.2007.03.019
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发表时间：
2007-07-01
影响因子：
12.6
通讯作者：
Donato, Francesco
中科院分区：
文献类型：
--
作者：
Corazza, Gino Roberto;Villanacci, Vincenzo;Donato, Francesco
背景与目的：目前，十二指肠粘膜病变的Marsh-Oberhuber分类用于乳糜泻。最近提出了一种更简化的分类，其基于3种绒毛形态（A，非萎缩; B1，萎缩，绒毛-隐窝比25/100肠细胞）。本研究的目的是评估不同病理学家根据Marsh-Oberhuber和新的分类系统对乳糜泻病变进行分类的观察者间一致性。研究方法：选择60名患者进行研究：10名无乳糜泻患者，13名绒毛正常但上皮内淋巴细胞病理性增加>25/100和增生性隐窝的乳糜泻患者，以及37名伴有绒毛萎缩的乳糜泻患者。将60张切片发送给6名病理学家，这些病理学家彼此不知情，未提供任何临床信息。每名病理学家在2个不同的场合收到一组活检标本，并根据两个分级系统以随机顺序对其进行评价。使用kappa统计量评估每对病理学家之间的一致性。结果：总体而言，Marsh-Oberhuber分类的平均kappa值为0.35（一般），而新分类系统的平均kappa值为0.55（中度）。结论：与更繁琐的Marsh-Oberhuber分类相比，乳糜泻十二指肠病理的新分类提供了更好的观察者间一致性，并有助于乳糜泻诊断的有效性。
Background & Aims: 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 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.