TY - JOUR
T1 - Roc-king onwards
T2 - Intraepithelial lymphocyte counts, distribution & role in coeliac disease mucosal interpretation
AU - Rostami, Kamran
AU - Marsh, Michael N.
AU - Johnson, Matt W.
AU - Mohaghegh, Hamid
AU - Heal, Calvin
AU - Holmes, Geoffrey
AU - Ensari, Arzu
AU - Aldulaimi, David
AU - Bancel, Brigitte
AU - Bassotti, Gabrio
AU - Bateman, Adrian
AU - Becheanu, Gabriel
AU - Bozzola, Anna
AU - Carroccio, Antonio
AU - Catassi, Carlo
AU - Ciacci, Carolina
AU - Ciobanu, Alexandra
AU - Danciu, Mihai
AU - Derakhshan, Mohammad H.
AU - Elli, Luca
AU - Ferrero, Stefano
AU - Fiorentino, Michelangelo
AU - Fiorino, Marilena
AU - Ganji, Azita
AU - Ghaffarzadehgan, Kamran
AU - Going, James J.
AU - Ishaq, Sauid
AU - Mandolesi, Alessandra
AU - Mathews, Sherly
AU - Maxim, Roxana
AU - Mulder, Chris J.
AU - Neefjes-Borst, Andra
AU - Robert, Marie
AU - Russo, Ilaria
AU - Rostami-Nejad, Mohammad
AU - Sidoni, Angelo
AU - Sotoudeh, Masoud
AU - Villanacci, Vincenzo
AU - Volta, Umberto
AU - Zali, Mohammad R.
AU - Srivastava, Amitabh
PY - 2017
Y1 - 2017
N2 - 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.
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.
UR - http://www.scopus.com/inward/record.url?scp=85034825043&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/gutjnl-2017-314297
DO - https://doi.org/10.1136/gutjnl-2017-314297
M3 - Article
C2 - 28893865
SN - 0017-5749
VL - 66
SP - 2080
EP - 2086
JO - Gut
JF - Gut
IS - 12
ER -