Immunohistochemical CD3 staining detects additional patients with celiac disease

Area of Science:

• Gastroenterology
• Immunohistochemistry
• Pediatric Pathology

Background:

• Celiac disease diagnosis relies on histological examination of duodenal biopsies.
• Intraepithelial lymphocytosis is a key indicator, but its detection can be challenging with standard hematoxylin and eosin (HE) staining.
• Discrepancies between serological tests and histological findings can occur.

Purpose of the Study:

• To evaluate the added diagnostic value of immunohistochemical CD3 staining for intraepithelial lymphocytosis in pediatric celiac disease.
• To determine if CD3 staining improves the accuracy of Marsh classification in celiac disease.

Main Methods:

• Biopsies from 159 children were initially stained with HE and assessed using the Marsh classification.
• CD3 staining was performed and evaluated independently.
• Results were compared between HE and CD3 staining, and correlated with serological findings.

Main Results:

• CD3 staining revealed discrepancies in 12.6% of cases compared to HE staining.
• Celiac disease diagnosis (Marsh II-III) was altered in 6.3% of patients, with 9 cases initially missed by HE.
• Detection of intraepithelial lymphocytosis (Marsh I) improved in 12.3% of patients, with 9 cases identified by CD3 staining but missed by HE.

Conclusions:

• Immunohistochemical CD3 staining offers significant additional value in the histological diagnosis of celiac disease.
• CD3 staining is recommended when histological findings on HE sections contradict serological results or when intraepithelial lymphocytosis is suspected but not clearly identified.