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J Clin Pathol doi:10.1136/jcp.2008.058669

Quantitative assessment of the degree of villous Atrophy in patients with Celiac disease

  1. Edward J Ciaccio (ejc6{at}columbia.edu)
  1. Columbia University, United States
    1. Govind Bhagat (gb96{at}columbia.edu)
    1. Columbia University, United States
      1. Afzal J Naiyer (ajn2102{at}columbia.edu)
      1. Columbia University, United States
        1. Lincoln Hernandez (hernandezmd{at}gmail.com)
        1. Columbia University, United States
          1. Peter HR Green (pg11{at}columbia.edu)
          1. Columbia University, United States
            • Published Online First 19 July 2008

            Abstract

            Background: Endoscopy and biopsy are used to diagnose celiac disease. There are however, observer dependent interpretations of the degree of villous atrophy in biopsies. We performed a pilot study using quantitative image processing procedures to quantify the degree of villous atrophy in patients with celiac 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 to the blinded assessment of Marsh score for degree of villous atrophy.

            Results: Mean E/P ratios for N=32 biopsy images: 2.76±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 nonparametric tests, E/P ratios were inversely correlated with the Marsh scores (Spearman’s coefficient ρ = ­0.798, Kendall’s τ = -0.681; p<0.0001).

            Conclusions: Biopsy images quantified by image analysis correlated exceedingly well with the histopathologic 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 standardization of histologic grading.

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