CD, or not CD, that is the question: a digital interobserver agreement study in coeliac disease

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY

BMJ Open Gastroenterology Pub Date : 2024-02-01 DOI:10.1136/bmjgast-2023-001252

James Denholm, Benjamin A Schreiber, Florian Jaeckle, Mike N Wicks, Emyr W Benbow, Tim S Bracey, James Y H Chan, Lorant Farkas, Eve Fryer, Kishore Gopalakrishnan, Caroline A Hughes, Kathryn J Kirkwood, Gerald Langman, Betania Mahler-Araujo, Raymond F T McMahon, Khun La Win Myint, Sonali Natu, Andrew Robinson, Ashraf Sanduka, Katharine A Sheppard, Yee Wah Tsang, Mark J Arends, Elizabeth J Soilleux

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引用次数: 0

Abstract

Objective Coeliac disease (CD) diagnosis generally depends on histological examination of duodenal biopsies. We present the first study analysing the concordance in examination of duodenal biopsies using digitised whole-slide images (WSIs). We further investigate whether the inclusion of immunoglobulin A tissue transglutaminase (IgA tTG) and haemoglobin (Hb) data improves the interobserver agreement of diagnosis. Design We undertook a large study of the concordance in histological examination of duodenal biopsies using digitised WSIs in an entirely virtual reporting setting. Our study was organised in two phases: in phase 1, 13 pathologists independently classified 100 duodenal biopsies (40 normal; 40 CD; 20 indeterminate enteropathy) in the absence of any clinical or laboratory data. In phase 2, the same pathologists examined the (re-anonymised) WSIs with the inclusion of IgA tTG and Hb data. Results We found the mean probability of two observers agreeing in the absence of additional data to be 0.73 (±0.08) with a corresponding Cohen’s kappa of 0.59 (±0.11). We further showed that the inclusion of additional data increased the concordance to 0.80 (±0.06) with a Cohen’s kappa coefficient of 0.67 (±0.09). Conclusion We showed that the addition of serological data significantly improves the quality of CD diagnosis. However, the limited interobserver agreement in CD diagnosis using digitised WSIs, even after the inclusion of IgA tTG and Hb data, indicates the importance of interpreting duodenal biopsy in the appropriate clinical context. It further highlights the unmet need for an objective means of reproducible duodenal biopsy diagnosis, such as the automated analysis of WSIs using artificial intelligence. No data are available. The raw data, along with the code and instructions for reproducing all of the analysis and figures presented in this work are available in THIS GITLAB REPOSITORY (). We are not at liberty to share the WSIs, however.

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是 CD，还是不是 CD，这就是问题所在：一项关于乳糜泻的数字观察者间一致性研究

目的：乳糜泻（CD）的诊断通常取决于十二指肠活检组织学检查。我们首次利用数字化全切片图像（WSI）对十二指肠活检组织检查的一致性进行了分析。我们还进一步研究了加入免疫球蛋白 A 组织转谷氨酰胺酶（IgA tTG）和血红蛋白（Hb）数据是否能提高观察者之间的诊断一致性。设计我们在完全虚拟的报告环境中使用数字化 WSI 对十二指肠活检组织学检查的一致性进行了一项大型研究。我们的研究分为两个阶段：在第一阶段，13 位病理学家在没有任何临床或实验室数据的情况下独立对 100 例十二指肠活检组织（40 例正常；40 例 CD；20 例不确定肠病）进行了分类。在第 2 阶段，同样的病理学家在加入 IgA tTG 和 Hb 数据后检查了（重新匿名的）WSI。结果我们发现，在没有额外数据的情况下，两名观察者达成一致的平均概率为 0.73 (±0.08)，相应的 Cohen's kappa 为 0.59 (±0.11)。我们进一步发现，加入额外数据后，一致性提高到 0.80 (±0.06)，科恩卡帕系数为 0.67 (±0.09)。结论我们的研究表明，加入血清学数据可显著提高 CD 诊断的质量。然而，即使在加入 IgA tTG 和 Hb 数据后，使用数字化 WSI 诊断 CD 的观察者间一致性仍然有限，这表明在适当的临床背景下解释十二指肠活检的重要性。这进一步凸显了对可重复十二指肠活检诊断客观方法的需求尚未得到满足，例如使用人工智能对 WSI 进行自动分析。无数据可用。原始数据、代码以及重现所有分析和图表的说明均可在本 GITLAB REPOSITORY () 中获取。不过，我们不能随意分享 WSI。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

5.90

自引率

3.20%

发文量

审稿时长

2 weeks

期刊介绍： BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.

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