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Gastric graft-versus-host disease: a blinded histologic study
K Washington1, R C Bentley, A Green
1Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
The American Journal of Surgical Pathology
|September 23, 1997
Summary
Diagnosing gastric graft-versus-host disease (GvHD) after bone marrow transplantation (BMT) requires histologic confirmation due to nonspecific clinical signs. This study evaluated diagnostic reproducibility and key histologic features for accurate GvHD identification.
Area of Science:
- Gastroenterology
- Hematology
- Pathology
Background:
- Acute graft-versus-host disease (GvHD) of the upper gastrointestinal tract is a frequent complication following allogeneic bone marrow transplantation (BMT).
- Clinical presentation and endoscopic findings for gastric GvHD are nonspecific, necessitating histologic confirmation for accurate diagnosis.
- Interpreting histologic features of gastric GvHD can be challenging due to subtle findings and potential variability.
Purpose of the Study:
- To evaluate the reproducibility of diagnosing gastric GvHD based on histologic features.
- To identify and assess the diagnostic utility of specific histologic markers for gastric GvHD.
- To differentiate gastric GvHD from other gastrointestinal conditions, such as cytomegalovirus (CMV) infection.
Main Methods:
- A blinded review of 56 gastric biopsies was conducted, including biopsies from patients who underwent BMT and control patients.
- Histologic criteria for GvHD included apoptosis, gland destruction, sparse inflammation, and granular eosinophilic debris.
- Diagnostic performance metrics (positive predictive value, sensitivity, specificity) were calculated for blinded histologic diagnosis.
Main Results:
- Histologic diagnosis of GvHD showed a positive predictive value of 69%, sensitivity of 82%, and specificity of 76%.
- Granular debris in glands was a highly specific (94%) but insensitive (41%) marker for GvHD.
- False-positive diagnoses occurred in cases of CMV gastritis, HIV infection, primary immunodeficiency, and post-renal transplantation.
Conclusions:
- Histologic evaluation is crucial for diagnosing gastric GvHD, but interpretation requires careful consideration of specific features.
- Distinguishing GvHD from CMV gastritis and other immunodeficiency-related changes can be difficult.
- Further refinement of diagnostic criteria may improve the accuracy of gastric GvHD detection.