From 2-dimensional to 3-dimensional: Overcoming dilemmas in intestinal mucosal interpretation

Area of Science:

• Gastroenterology
• Histopathology
• Diagnostic Pathology

Background:

• Coeliac disease diagnosis relies on small intestinal histology.
• Historical interpretations of coeliac lesions present significant challenges.
• Inaccuracies in assessing intraepithelial lymphocytes and villous atrophy persist.

Purpose of the Study:

• To provide a definitive account of small intestinal mucosal structure and interpretation.
• To identify interpretative difficulties in the histological assessment of coeliac disease.
• To establish a 3-dimensional framework for understanding mucosal structure.

Main Methods:

• Critical review of historical and current histological assessment methods for coeliac disease.
• Analysis of interpretative pitfalls in 2D tissue sections.
• Synthesis of 70 years of study into a 3D mucosal structure framework.

Main Results:

• Early histological assessments of coeliac disease were often inaccurate.
• 2D histological sections present inherent limitations in representing 3D tissue structure.
• Persistent interpretive challenges can lead to diagnostic errors in coeliac disease.

Conclusions:

• Existing 2D-based interpretative errors in coeliac histology should be reconsidered.
• A 3D understanding of small intestinal mucosal structure is crucial for accurate diagnosis.
• This review offers a framework for improved histological interpretation of coeliac disease.