ORIGINAL ARTICLES

Quantitative assessment of the degree of villous atrophy in patients with coeliac disease

E J Ciaccio^1,2, G Bhagat³, A J Naiyer⁴, L Hernandez⁴ and P H R Green⁴

¹ Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, USA
² Department of Biomedical Engineering, Columbia University College of Physicians and Surgeons, New York, USA
³ Department of Pathology, Columbia University College of Physicians and Surgeons, New York, USA
⁴ Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA

Correspondence to:
Dr E J Ciaccio, Celiac Disease Center at Columbia University, 180 Fort Washington Avenue, New York, NY 10032, USA; ciaccio{at}columbia.edu

Background: Endoscopy and biopsy are used to diagnose coeliac disease. There are, however, observer-dependent interpretations of the degree of villous atrophy in biopsies. A pilot study using quantitative image-processing procedures was performed to quantify the degree of villous atrophy in patients with coeliac disease.

Method: The degree of villous atrophy in duodenal biopsy images was quantified by calculating the ratio of villous edge-to-piecewise arc length (E/P ratio), and this value was compared with the blinded assessment of Marsh score for degree of villous atrophy.

Results: Mean E/P ratios for n = 31 biopsy images, 2.76 (SD 0.44) (Marsh IIIa), 1.91 (0.50) (Marsh IIIb) and 1.18 (0.22) (Marsh IIIc), were significantly different (p = 0.006). Based on non-parametric testing, the E/P ratios were inversely correlated with Marsh scores (Spearman coefficient = –0.798, Kendall = –0.681; p<0.0001).

Conclusions: Biopsy images quantified by image analysis correlated exceedingly well with the histopathological grade of villous atrophy. Since quantified measurements are real-numbered values and lack observer bias, measurement of villous atrophy based on image analysis lends itself to standardisation of histological grading.

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