ROC-king onwards: intraepithelial lymphocyte counts, distribution & role in coeliac disease mucosal interpretation
作者:Kamran Rostami,1 Michael N Marsh,2,3 Matt W Johnson,2 Hamid Mohaghegh,4 Calvin Heal, 5 Geoffrey Holmes,6 Arzu Ensari, 7 David Aldulaimi,8 Brigitte Bancel,9 Gabrio Bassotti, 10
摘要: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.
关键词:Coeliac disease
论文方向:[{"id":896,"name":"医药科学"},{"id":899,"name":"消化系统"}]
发表期刊:
数字识别码:doi:10.1136/gutjnl-2017-314297
是否作者本人: 否
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