TY - JOUR
T1 - CD, or not CD, that is the question
T2 - a digital interobserver agreement study in coeliac disease
AU - Denholm, James
AU - Schreiber, Benjamin A
AU - Jaeckle, Florian
AU - Wicks, Mike N
AU - Benbow, Emyr W
AU - Bracey, Tim S
AU - Chan, James Y H
AU - Farkas, Lorant
AU - Fryer, Eve
AU - Gopalakrishnan, Kishore
AU - Hughes, Caroline A
AU - Kirkwood, Kathryn J
AU - Langman, Gerald
AU - Mahler-Araujo, Betania
AU - McMahon, Raymond F T
AU - Myint, Khun La Win
AU - Natu, Sonali
AU - Robinson, Andrew
AU - Sanduka, Ashraf
AU - Sheppard, Katharine A
AU - Tsang, Yee Wah
AU - Arends, Mark J
AU - Soilleux, Elizabeth J
N1 - © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024/2/1
Y1 - 2024/2/1
N2 - OBJECTIVE: Coeliac disease (CD) diagnosis generally depends on histological examination of duodenal biopsies. We present the first study analysing the concordance in examination of duodenal biopsies using digitised whole-slide images (WSIs). We further investigate whether the inclusion of immunoglobulin A tissue transglutaminase (IgA tTG) and haemoglobin (Hb) data improves the interobserver agreement of diagnosis.DESIGN: We undertook a large study of the concordance in histological examination of duodenal biopsies using digitised WSIs in an entirely virtual reporting setting. Our study was organised in two phases: in phase 1, 13 pathologists independently classified 100 duodenal biopsies (40 normal; 40 CD; 20 indeterminate enteropathy) in the absence of any clinical or laboratory data. In phase 2, the same pathologists examined the (re-anonymised) WSIs with the inclusion of IgA tTG and Hb data.RESULTS: We found the mean probability of two observers agreeing in the absence of additional data to be 0.73 (±0.08) with a corresponding Cohen's kappa of 0.59 (±0.11). We further showed that the inclusion of additional data increased the concordance to 0.80 (±0.06) with a Cohen's kappa coefficient of 0.67 (±0.09).CONCLUSION: We showed that the addition of serological data significantly improves the quality of CD diagnosis. However, the limited interobserver agreement in CD diagnosis using digitised WSIs, even after the inclusion of IgA tTG and Hb data, indicates the importance of interpreting duodenal biopsy in the appropriate clinical context. It further highlights the unmet need for an objective means of reproducible duodenal biopsy diagnosis, such as the automated analysis of WSIs using artificial intelligence.
AB - OBJECTIVE: Coeliac disease (CD) diagnosis generally depends on histological examination of duodenal biopsies. We present the first study analysing the concordance in examination of duodenal biopsies using digitised whole-slide images (WSIs). We further investigate whether the inclusion of immunoglobulin A tissue transglutaminase (IgA tTG) and haemoglobin (Hb) data improves the interobserver agreement of diagnosis.DESIGN: We undertook a large study of the concordance in histological examination of duodenal biopsies using digitised WSIs in an entirely virtual reporting setting. Our study was organised in two phases: in phase 1, 13 pathologists independently classified 100 duodenal biopsies (40 normal; 40 CD; 20 indeterminate enteropathy) in the absence of any clinical or laboratory data. In phase 2, the same pathologists examined the (re-anonymised) WSIs with the inclusion of IgA tTG and Hb data.RESULTS: We found the mean probability of two observers agreeing in the absence of additional data to be 0.73 (±0.08) with a corresponding Cohen's kappa of 0.59 (±0.11). We further showed that the inclusion of additional data increased the concordance to 0.80 (±0.06) with a Cohen's kappa coefficient of 0.67 (±0.09).CONCLUSION: We showed that the addition of serological data significantly improves the quality of CD diagnosis. However, the limited interobserver agreement in CD diagnosis using digitised WSIs, even after the inclusion of IgA tTG and Hb data, indicates the importance of interpreting duodenal biopsy in the appropriate clinical context. It further highlights the unmet need for an objective means of reproducible duodenal biopsy diagnosis, such as the automated analysis of WSIs using artificial intelligence.
KW - Humans
KW - Celiac Disease/diagnosis
KW - Transglutaminases
KW - Artificial Intelligence
KW - Observer Variation
KW - Immunoglobulin A
UR - http://www.scopus.com/inward/record.url?scp=85184072684&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/96e75b8d-4739-3af6-b3a9-426800cda2ee/
U2 - 10.1136/bmjgast-2023-001252
DO - 10.1136/bmjgast-2023-001252
M3 - Article
C2 - 38302475
SN - 2054-4774
VL - 11
JO - BMJ Open Gastroenterology
JF - BMJ Open Gastroenterology
IS - 1
M1 - e001252
ER -