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 Rostami, Kamran
A1 Marsh, Michael N
A1 Johnson, Matt W
A1 Mohaghegh, Hamid
A1 Heal, Calvin
A1 Holmes, Geoffrey
A1 Ensari, Arzu
A1 Aldulaimi, David
A1 Bancel, Brigitte
A1 Bassotti, Gabrio
A1 Bateman, Adrian
A1 Becheanu, Gabriel
A1 Bozzola, Anna
A1 Carroccio, Antonio
A1 Catassi, Carlo
A1 Ciacci, Carolina
A1 Ciobanu, Alexandra
A1 Danciu, Mihai
A1 Derakhshan, Mohammad H
A1 Elli, Luca
A1 Ferrero, Stefano
A1 Fiorentino, Michelangelo
A1 Fiorino, Marilena
A1 Ganji, Azita
A1 Ghaffarzadehgan, Kamran
A1 Going, James J
A1 Ishaq, Sauid
A1 Mandolesi, Alessandra
A1 Mathews, Sherly
A1 Maxim, Roxana
A1 Mulder, Chris J
A1 Neefjes-Borst, Andra
A1 Robert, Marie
A1 Russo, Ilaria
A1 Rostami-Nejad, Mohammad
A1 Sidoni, Angelo
A1 Sotoudeh, Masoud
A1 Villanacci, Vincenzo
A1 Volta, Umberto
A1 Zali, Mohammad R
A1 Srivastava, Amitabh
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.