Validity of histology for the diagnosis of XXXX : a Swedish multicentre study.

@entity1 @entity66 @entity8265
UNASSIGNED: Objective Histological evaluation of intestinal biopsies for the diagnosis of @entity66 can be challenging and compatible with risk of misdiagnosis. The aim was to evaluate the agreement of pathological diagnosis for @entity66 in @entity1 investigated at four major paediatric university hospitals in Sweden. Materials and methods Intestinal duodenal biopsies were collected from 402 @entity1 at median 9.7 years (1.4-18.3 years). A pathologist at each hospital performed the primary evaluation. A designated pathologist, blinded to the primary evaluation, performed a second Marsh classification of biopsies (M0 to M3c) taken from the bulb and duodenum separately. Kappa (k) scores between first and second evaluation determined the agreement. Plasma samples were collected at the day of intestinal biopsy and analysed for @entity8265 autoantibodies (tTGA) using radioligand-binding assays. Results Marsh scores were concordant in 229/356 biopsies (64%, k   =   0.52, p   <   0.0001). Among discordant results, 15/127 (12%) showed M0 in distal duodenum but >=    M2 in the bulb, whereas the opposite was true for 8/127 (6%) of the biopsies. There were fewer collected duodenal biopsies, more missing bulb biopsies and missing CD3 staining among discordant evaluations. The second evaluation revealed a Marsh score compliant with @entity66 in 22 @entity1 of whom seven @entity1 were tTGA positive. Conclusions The variation between university hospitals on the pathological evaluation of biopsies may lead to misdiagnosis of @entity66 in paediatric @entity1 . Access to clinical and endoscopic information as well as tTGA levels may be useful for the pathologist to complement the evaluation in dubious cases.
