Diagnostic disagreement between clinical standard histopathological- and retrospective assessment of histopathology-based gastrointestinal graft-versus-host disease in children
(2020) In Pediatric Transplantation 24(8).- Abstract
Background: No previous paediatric study has evaluated the frequency of diagnostic disagreement between clinical standard histopathological assessment (CSHA) and retrospective, independent, histopathological assessment (RIHA) of gastrointestinal Graft-Versus-Host Disease (GI-GVHD). Methods: In a retrospective cohort study, based on gastrointestinal biopsies collected from allogeneic HSCT-treated children (<18 years) with symptom-based GI-GVHD, we evaluated; disagreement of histopathology-based GI-GVHD diagnosis in CSHA vs RIHA, and potential clinical consequences of differences between the assessments. The CSHA-based diagnoses were retrieved from histopathology reports. The RIHA was performed by one pathologist, blinded to the CSHA... (More)
Background: No previous paediatric study has evaluated the frequency of diagnostic disagreement between clinical standard histopathological assessment (CSHA) and retrospective, independent, histopathological assessment (RIHA) of gastrointestinal Graft-Versus-Host Disease (GI-GVHD). Methods: In a retrospective cohort study, based on gastrointestinal biopsies collected from allogeneic HSCT-treated children (<18 years) with symptom-based GI-GVHD, we evaluated; disagreement of histopathology-based GI-GVHD diagnosis in CSHA vs RIHA, and potential clinical consequences of differences between the assessments. The CSHA-based diagnoses were retrieved from histopathology reports. The RIHA was performed by one pathologist, blinded to the CSHA outcomes and based on the minimal criteria for histopathology-based GI-GVHD diagnosis by the NIH 2014. Results: Seventy children with 92 endoscopic occasions (including 22 re-endoscopies) were enrolled. GI-GVHD was observed in 73% (67/92) of the endoscopies in the RIHA and in 54% (50/92) in the CSHA (P =.014). The RIHA confirmed 94% (47/50) with GI-GVHD and 52% (22/42) with non-GI-GVHD diagnoses, established in the CSHA. Disagreement, that is endoscopic occasions with GI-GVHD solely detected in RIHA or detection of GI-GVHD in CSHA but not in RIHA, was observed in 20/42 (48%) and 3/50 (6%), respectively (McNemar's test, P =.0008). The risk of a subsequent re-endoscopy was higher in endoscopic occasions with GI-GVHD detected in RIHA but not in CSHA vs if non-GI-GVHD were detected in both readings (P =.005). Conclusion: Our results suggest that in children with symptom-based GI-GVHD without histopathological confirmation in CSHA, a second, NIH 2014 based histopathological assessment should be considered before performing a re-endoscopy.
(Less)
- author
- Mårtensson, Thomas ; Szakos, Attila ; Mellgren, Karin ; Toporski, Jacek LU ; Arvidson, Johan ; Mattsson, Jonas ; Gustafsson, Britt and Casswall, Thomas H.
- publishing date
- 2020-10-21
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- children, endoscopy, gastrointestinal graft-versus-host disease, hematopoietic stem cell transplantation, histopathology
- in
- Pediatric Transplantation
- volume
- 24
- issue
- 8
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:33085820
- scopus:85092889529
- ISSN
- 1397-3142
- DOI
- 10.1111/petr.13824
- language
- English
- LU publication?
- no
- id
- 01940b6a-4286-4d93-b2ef-b13680578a3c
- date added to LUP
- 2020-11-12 13:28:01
- date last changed
- 2024-04-03 17:30:06
@article{01940b6a-4286-4d93-b2ef-b13680578a3c,
abstract = {{<p>Background: No previous paediatric study has evaluated the frequency of diagnostic disagreement between clinical standard histopathological assessment (CSHA) and retrospective, independent, histopathological assessment (RIHA) of gastrointestinal Graft-Versus-Host Disease (GI-GVHD). Methods: In a retrospective cohort study, based on gastrointestinal biopsies collected from allogeneic HSCT-treated children (<18 years) with symptom-based GI-GVHD, we evaluated; disagreement of histopathology-based GI-GVHD diagnosis in CSHA vs RIHA, and potential clinical consequences of differences between the assessments. The CSHA-based diagnoses were retrieved from histopathology reports. The RIHA was performed by one pathologist, blinded to the CSHA outcomes and based on the minimal criteria for histopathology-based GI-GVHD diagnosis by the NIH 2014. Results: Seventy children with 92 endoscopic occasions (including 22 re-endoscopies) were enrolled. GI-GVHD was observed in 73% (67/92) of the endoscopies in the RIHA and in 54% (50/92) in the CSHA (P =.014). The RIHA confirmed 94% (47/50) with GI-GVHD and 52% (22/42) with non-GI-GVHD diagnoses, established in the CSHA. Disagreement, that is endoscopic occasions with GI-GVHD solely detected in RIHA or detection of GI-GVHD in CSHA but not in RIHA, was observed in 20/42 (48%) and 3/50 (6%), respectively (McNemar's test, P =.0008). The risk of a subsequent re-endoscopy was higher in endoscopic occasions with GI-GVHD detected in RIHA but not in CSHA vs if non-GI-GVHD were detected in both readings (P =.005). Conclusion: Our results suggest that in children with symptom-based GI-GVHD without histopathological confirmation in CSHA, a second, NIH 2014 based histopathological assessment should be considered before performing a re-endoscopy.</p>}},
author = {{Mårtensson, Thomas and Szakos, Attila and Mellgren, Karin and Toporski, Jacek and Arvidson, Johan and Mattsson, Jonas and Gustafsson, Britt and Casswall, Thomas H.}},
issn = {{1397-3142}},
keywords = {{children; endoscopy; gastrointestinal graft-versus-host disease; hematopoietic stem cell transplantation; histopathology}},
language = {{eng}},
month = {{10}},
number = {{8}},
publisher = {{Wiley-Blackwell}},
series = {{Pediatric Transplantation}},
title = {{Diagnostic disagreement between clinical standard histopathological- and retrospective assessment of histopathology-based gastrointestinal graft-versus-host disease in children}},
url = {{http://dx.doi.org/10.1111/petr.13824}},
doi = {{10.1111/petr.13824}},
volume = {{24}},
year = {{2020}},
}