6533b86dfe1ef96bd12ca969
RESEARCH PRODUCT
ROC-king onwards: intraepithelial lymphocyte counts, distribution & role in coeliac disease mucosal interpretation
Ilaria RussoAndra Neefjes-borstKamran GhaffarzadehganVincenzo VillanacciAnna BozzolaMatt W JohnsonAzita GanjiMohammad H. DerakhshanMohammad H. DerakhshanAlessandra MandolesiAlexandra CiobanuAngelo SidoniArzu EnsariGeoffrey HolmesMarie E. RobertMarilena FiorinoMichael N. MarshStefano FerreroJames J. GoingMasoud SotoudehDavid AldulaimiKamran RostamiHamid MohagheghMihai DanciuCarlo CatassiAntonio CarroccioChris J. J. MulderBrigitte BancelAmitabh SrivastavaCalvin HealGabrio BassottiCarolina CiacciSauid IshaqLuca ElliMohammad Reza ZaliMohammad Rostami-nejadAdrian C BatemanUmberto VoltaRoxana MaximMichelangelo FiorentinoGabriel BecheanuSherly Mathewssubject
MalePathologySettore MED/09 - Medicina Interna2312ROC-curve analysiBiopsyCoeliac diseaseSerology0302 clinical medicineintraepithelial lymphocytesDiagnosis80 and overROC-curve analysis; coeliac disease; intraepithelial lymphocytes1506LymphocytesIntestinal MucosaChild1507medicine.diagnostic_testArea under the curveGastroenterologyhemic and immune systemsMiddle AgedPrognosis030220 oncology & carcinogenesis030211 gastroenterology & hepatologyFemalemedicine.symptomtissuesAdultmedicine.medical_specialtyAdolescentchemical and pharmacologic phenomenaBiologydigestive systemLesion03 medical and health sciencesBiopsymedicineHumansLymphocyte CountPreschoolAgedReceiver operating characteristicInfantHistologymedicine.diseaseNewbornROC-curve analysis; coeliac disease; intraepithelial lymphocytes; Adolescent; Adult; Aged; Aged 80 and over; Biopsy; Case-Control Studies; Celiac Disease; Child; Child Preschool; Diagnosis Differential; Female; Humans; Infant; Infant Newborn; Intestinal Mucosa; Lymphocyte Count; Lymphocytes; Male; Middle Aged; Prognosis; ROC Curve; GastroenterologyCeliac DiseaseROC CurveCase-Control StudiesDifferentialIntraepithelial lymphocyteROC-curve analysiscoeliac diseasedescription
ObjectivesCounting intraepithelial lymphocytes (IEL) is central to the histological diagnosis of coeliac disease (CD), but no definitive ‘normal’ IEL range has ever been published. In this multicentre study, receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off between normal and CD (Marsh III lesion) duodenal mucosa, based on IEL counts on >400 mucosal biopsy specimens.DesignThe study was designed at the International Meeting on Digestive Pathology, Bucharest 2015. Investigators from 19 centres, eight countries of three continents, recruited 198 patients with Marsh III histology and 203 controls and used one agreed protocol to count IEL/100 enterocytes in well-oriented duodenal biopsies. Demographic and serological data were also collected.ResultsThe mean ages of CD and control groups were 45.5 (neonate to 82) and 38.3 (2–88) years. Mean IEL count was 54±18/100 enterocytes in CD and 13±8 in normal controls (p=0.0001). ROC analysis indicated an optimal cut-off point of 25 IEL/100 enterocytes, with 99% sensitivity, 92% specificity and 99.5% area under the curve. Other cut-offs between 20 and 40 IEL were less discriminatory. Additionally, there was a sufficiently high number of biopsies to explore IEL counts across the subclassification of the Marsh III lesion.ConclusionOur ROC curve analyses demonstrate that for Marsh III lesions, a cut-off of 25 IEL/100 enterocytes optimises discrimination between normal control and CD biopsies. No differences in IEL counts were found between Marsh III a, b and c lesions. There was an indication of a continuously graded dose–response by IEL to environmental (gluten) antigenic influence.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2017-12-01 |