Article ; Online: Use of the National Institutes of Health Consensus Guidelines Improves the Diagnostic Sensitivity of Gastrointestinal Graft-Versus-Host Disease.
Archives of pathology & laboratory medicine
2018 Volume 142, Issue 9, Page(s) 1098–1105
Abstract: Context: - Graft-versus-host disease of the gastrointestinal tract is a common complication of hematopoietic stem cell transplant associated with significant morbidity and mortality. Accurate diagnosis can be difficult and is a truly clinicopathologic ... ...
| Abstract | Context: - Graft-versus-host disease of the gastrointestinal tract is a common complication of hematopoietic stem cell transplant associated with significant morbidity and mortality. Accurate diagnosis can be difficult and is a truly clinicopathologic endeavor. Objectives: - To assess the diagnostic sensitivity of gastrointestinal graft-versus-host disease using the 2015 National Institutes of Health (NIH) histology consensus guidelines and to analyze histologic findings that support the guidelines. Design: - Patients with allogeneic hematopoietic stem cell transplants were identified via a retrospective search of our electronic medical records from January 1, 2005, to January 1, 2011. Endoscopies with available histology were reviewed by 2 pathologists using the 2015 NIH guidelines. The clinical diagnosis was used as the gold standard. A nontransplant set of endoscopic biopsies was used as a control. Results: - Of the 250 total endoscopies, 217 (87%) had a clinical diagnosis of gastrointestinal graft-versus-host disease. Use of the NIH consensus guidelines showed a sensitivity of 86% and a specificity of 65%. Thirty-seven of 58 (64%) cases with an initial false-negative histopathologic diagnosis were diagnosed as graft-versus-host disease on our review. Conclusions: - Use of the NIH histology consensus guidelines results in a high sensitivity and specificity, thereby decreasing false-negatives. Additionally, use of the NIH guidelines aids in creating uniformity and diagnostic clarity. Correlation with clinical and laboratory findings is critical in evaluating the differential diagnosis and to avoid false-positives. As expected, increased apoptosis with decreased inflammation was associated with a pathologic diagnosis of graft-versus-host disease and supports the NIH guidelines. |
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| MeSH term(s) | Gastrointestinal Diseases/diagnosis ; Gastrointestinal Diseases/etiology ; Gastrointestinal Diseases/pathology ; Graft vs Host Disease/diagnosis ; Graft vs Host Disease/etiology ; Graft vs Host Disease/pathology ; Hematopoietic Stem Cell Transplantation/adverse effects ; Humans ; National Institutes of Health (U.S.) ; Practice Guidelines as Topic ; Retrospective Studies ; United States |
| Language | English |
| Publishing date | 2018-04-26 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 194119-7 |
| ISSN | 1543-2165 ; 0363-0153 ; 0096-8528 ; 0003-9985 |
| ISSN (online) | 1543-2165 |
| ISSN | 0363-0153 ; 0096-8528 ; 0003-9985 |
| DOI | 10.5858/arpa.2017-0054-OA |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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