RT Journal Article
SR Electronic
T1 ROC-king onwards: intraepithelial lymphocyte counts, distribution & role in coeliac disease mucosal interpretation
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 2080
OP 2086
DO 10.1136/gutjnl-2017-314297
VO 66
IS 12
A1 Kamran Rostami
A1 Michael N Marsh
A1 Matt W Johnson
A1 Hamid Mohaghegh
A1 Calvin Heal
A1 Geoffrey Holmes
A1 Arzu Ensari
A1 David Aldulaimi
A1 Brigitte Bancel
A1 Gabrio Bassotti
A1 Adrian Bateman
A1 Gabriel Becheanu
A1 Anna Bozzola
A1 Antonio Carroccio
A1 Carlo Catassi
A1 Carolina Ciacci
A1 Alexandra Ciobanu
A1 Mihai Danciu
A1 Mohammad H Derakhshan
A1 Luca Elli
A1 Stefano Ferrero
A1 Michelangelo Fiorentino
A1 Marilena Fiorino
A1 Azita Ganji
A1 Kamran Ghaffarzadehgan
A1 James J Going
A1 Sauid Ishaq
A1 Alessandra Mandolesi
A1 Sherly Mathews
A1 Roxana Maxim
A1 Chris J Mulder
A1 Andra Neefjes-Borst
A1 Marie Robert
A1 Ilaria Russo
A1 Mohammad Rostami-Nejad
A1 Angelo Sidoni
A1 Masoud Sotoudeh
A1 Vincenzo Villanacci
A1 Umberto Volta
A1 Mohammad R Zali
A1 Amitabh Srivastava
YR 2017
UL http://gut.bmj.com/content/66/12/2080.abstract
AB Objectives Counting 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.Design The 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.Results The 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.Conclusion Our 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.