What is the most reproducible histopathological classification for celiac disease? study of the interobserver variability in a serie of 69 cases

Abstract

The Marsh classification, as modified by Oberhuber et al. based on 6 stage grading, has been accepted as a worldwide standard, but the considerable number of diagnostic categories involved makes it prone to a low interobserver and intraobserver agreement, and given the therapeutic issues, a more reproducible histological classification is essential in order to better classify the villous atrophy. A more simplified classification, which is based on 3 villous morphologies and an intraepithelial lymphocyte count of greater than 25/100 enterocytes, has been proposed by Corazza. The aim of the present study was to evaluate the interobserver agreement in classifying celiac disease lesions according to both the Marsh-Oberhuber classification and new grading system proposed by Corazza. Sixty-nine cases of villous atrophy were selected for the study. The slides of duodenal biopsy specimens were reread by two pathologists, who were not given any clinical or biological information, and had to evaluate them according to both grading systems. The kappa statistic was used to assess agreement between the two pathologists. Overall mean kappa values were 0.48 (moderate) for the Marsh-Oberhuber classification versus 0.61 (good) for the Corazza classification system. The main finding of the study was a high interobserver variability between the two pathologists when using the Marsh-Oberhuber system of grading compared to the Cozarra classification.

Keywords

• celiac disease
• marsh–oberhuber classification
• cozarra classification
• interobserver variability