A retrospective analysis of interobserver variability in 356 cases over a period 10 years: Celiac disease

Celiac disease (CD) is an immune-mediated enteropathy in which dietary gluten triggers a T-cell-driven inflammatory injury of the small-intestinal mucosa in genetically predisposed individuals. Therefore, it is of interest to compare the distribution of the diagnostic categories and the interobserver variation of the Modified Marsh-Oberhuber and Corazza-Villanacci histopathological categories in biopsy-proven celiac disease samples of 356 cases collected in 10 years. All duodenal biopsies were reviewed by two independent pathologists who scored it twice with each of the two systems; Cohen concordance was used as a measure of interobserver agreement. Majority of initial diagnoses were compressed in Marsh III subtypes and recategorization showed significant discordance of Marsh (iii) a to (iii) c, which represents little reproducibility. By contrast, Corazza-Villanacci produced majority of Grade B1 tasks with maximal consensus among pathologists, which was highly reproducible and did not compromise clinically valuable stratification. The results argue in favor of the straightforward implementation of the streamlined Corazza-Villanacci system in Indian high throughput settings to increase the consistency of the diagnoses and standardize patient care.