Histopathological evaluation of duodenal biopsy in the PreventCD project. An observational interobserver agreement study

APMIS. 2018 Mar;126(3):208-214. doi: 10.1111/apm.12812. Epub 2018 Jan 26.

Abstract

Aim of the current study was to evaluate the inter-observer agreement between pathologists in the diagnosis of celiac disease (CD), in the qualified context of a multicenter study. Biopsies from the "PreventCD" study, a multinational- prospective- randomized study in children with at least one-first-degree relative with CD and positive for HLA-DQ2/HLA-DQ8. Ninety-eight biopsies were evaluated. Considering diagnostic samples with villous atrophy (VA), the agreement was satisfactory (κ = 0.84), but much less when assessing the severity of these lesions. The use of the recently proposed Corazza-Villanacci classification showed a moderately higher level of agreement (κ = 0.39) than using the Marsh-Oberhuber system (κ = 0.31). 57.1% of cases were considered correctly oriented. A number of >4 samples per patient was statistically associated to a better agreement; orientation did not impact on κ values. Agreement results in this study appear more satisfactory than in previous papers and this is justified by the involvement of centers with experience in CD diagnosis and by the well-controlled setting. Despite this, the reproducibility was far from optimal with a poor agreement in grading the severity of VA. Our results stress the need of a minimum of four samples to be assessed by the pathologist.

Keywords: Histopathology; children; coeliac disease; villous atrophy; κ value.

Publication types

  • Multicenter Study
  • Observational Study
  • Randomized Controlled Trial

MeSH terms

  • Biopsy
  • Celiac Disease / diagnosis*
  • Celiac Disease / pathology*
  • Child
  • Child, Preschool
  • Duodenum / pathology
  • HLA-DQ Antigens / immunology*
  • Humans
  • Infant
  • Intestinal Mucosa / pathology*
  • Observer Variation
  • Prospective Studies
  • Reproducibility of Results

Substances

  • HLA-DQ Antigens
  • HLA-DQ2 antigen
  • HLA-DQ8 antigen