Evaluation and Specification of Intraepithelial Lymphocyte Cut-off Point with Hematoxiline-Eosine (H&E) and Immunohistochemistry (CD3 Marker) in Duodenal Biopsy of Children with Celiac Disease

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Resident, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Some of studies showed intraepithelial lymphocyte and CD3 marker can be used in diagnosis of celiac disease with a high sensitivity and specificity, but there is controversy in these studies. This study aimed to evaluate and specify the cut-off point of intraepithelial lymphocyte with Hematoxiline-eosine (H&E) and immunohistochemistry (CD3 marker) in duodenal biopsy of children with celiac disease.Methods: In this cross-sectional study, 113 under 12-years-old children candidated for duodenal biopsy were enrolled. The number of intraepithelial lymphocytes in Hematoxiline-eosine and CD3 methods were determined, and based on pathology results, the cut-off points and diagnostic values of the two methods were calculated.Findings: The best cut-off points for Hematoxiline-eosine and CD3 methods was 16 and 18, respectively. The sensitivity, specificity, false positive, false negative, positive predictive value, negative predictive value, and accuracy were 93.8, 86.6, 13.4, 6.3, 53.6, 98.8, and 87.6 percent for Hematoxiline-eosine, and 87.5, 93.8, 6.2, 12.5, 70.0, 97.8, and 92.9 percent for CD3, respectively.Conclusion: Count of intraepithelial lymphocytes along with CD3 marker can help to detect celiac disease, especially when there is a controversy in between Hematoxiline-eosine and serology results. More studies is recommended to detect diagnostic values of these markers better.

Keywords

References

  1. Rosai J. Gastrointestinal Tract. In: Rosai J, editor. Rosai and Ackerman's surgical pathology. Philadelphia, PA: Mosby; 2004. p. 716-7.
  2. Sood M. Disorders of malabsorption. In: Kliegman R, Behrman R, Jenson H, Stanton B, editors. Nelson textbook of pediatrics. 18thed. Philadelphia, PA: Saunders; 2007; p.1591-3. vol 2.
  3. Troncone R, Auricchio S. Celiac disease. In: Wyllie R, Hyms J, Kay M, editor. Pediatric gastrointestinal and liver disease. 4th ed. Saint Louis, MO: Saunders; 2011. p. 366-73.
  4. Tollefsen S, Arentz-Hansen H, Fleckenstein B, Molberg O, Raki M, Kwok WW, et al. HLA-DQ2 and -DQ8 signatures of gluten T cell epitopes in celiac disease. J Clin Invest 2006; 116(8): 2226-36.
  5. Tajik P. Celiac disease overview in children by focused on Iranian studies. International Journal of Celiac Disease 2014; 2(4): 121-5.
  6. Polanco I. Celiac disease in children. In: Rodrigo L, Salvador Pena A. Celiac disease and non-celiac gluten sensitivity. 1st ed. Terrassa, Spain: Omnia Science; 2014. p. 221-34 .
  7. Guz-Mark A, Zevit N, Morgenstern S, Shamir R. Duodenal intraepithelial lymphocytosis is common in children without coeliac disease, and is not meaningfully influenced by Helicobacter pylori infection. Aliment Pharmacol Ther 2014; 39(11): 1314-20.
  8. Kakar S, Nehra V, Murray JA, Dayharsh GA, Burgart LJ. Significance of intraepithelial lymphocytosis in small bowel biopsy samples with normal mucosal architecture. Am J Gastroenterol 2003; 98(9): 2027-33.
  9. Valdimarsson T, Franzen L, Grodzinsky E, Skogh T, Strom M. Is small bowel biopsy necessary in adults with suspected celiac disease and IgA anti-endomysium antibodies? 100% positive predictive value for celiac disease in adults. Dig Dis Sci 1996; 41(1): 83-7.
  10. Fasano A, Troncone R, Branski D. Frontiers in celiac disease. Basel, Switzerland: Karger; 2008. vol 12.
  11. Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2005; 40(1): 1-19.
  12. Ghergherehchi, R, Rafeey M, Majidi J, Majidi S. Prevalence of Celiac Disease in Type 1 Diabetic Children and adolescents in East Azarbaijan. J Babol Univ Med Sci 2010; 11(6): 40-5. [In Persian].
  13. Rajabiani A, Aaliepour A, Tavangar S M, Meysamie A P. A comparison of H&E staining and IHC study in quantization of duodenal intra-epithelial lymphocytes. Yafte 2008; 9(4): 51-7. [In Persian].
  14. Mubarak A, Wolters VM, Houwen RH, ten Kate FJ. Immunohistochemical CD3 staining detects additional patients with celiac disease. World J Gastroenterol 2015; 21(24): 7553-7.
  15. Tosco A, Maglio M, Paparo F, Greco L, Troncone R, Auricchio R. Discriminant score for celiac disease based on immunohistochemical analysis of duodenal biopsies. J Pediatr Gastroenterol Nutr 2015; 60(5): 621-5.
  16. Lonardi S, Villanacci V, Lorenzi L, Lanzini A, Lanzarotto F, Carabellese N, et al. Anti-TCR gamma antibody in celiac disease: the value of count on formalin-fixed paraffin-embedded biopsies. Virchows Arch 2013; 463(3): 409-13.
  17. Hudacko R, Kathy Z, X, Yantiss RK. Immunohistochemical stains for CD3 and CD8 do not improve detection of gluten-sensitive enteropathy in duodenal biopsies. Mod Pathol 2013; 26(9): 1241-5.
  18. Pellegrino S, Villanacci V, Sansotta N, Scarfi R, Bassotti G, Vieni G, et al. Redefining the intraepithelial lymphocytes threshold to diagnose gluten sensitivity in patients with architecturally normal duodenal histology. Aliment Pharmacol Ther 2011; 33(6): 697-706.
Journal of Isfahan Medical School
Volume 36, Issue 467 - Serial Number 467
January and February 2018
Pages 83-89

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History

  • Receive Date: 29 August 2017
  • Revise Date: 02 November 2024
  • Accept Date: 06 April 2022

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