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

James Denholm, Benjamin A Schreiber, Florian Jaeckle, Mike Wicks, Emyr W Benbow, Tim S Bracey, James Y H Chan, Lorant Farkas, Eve Fryer, Kishore Gopalakrishnan, Caroline 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 SheppardYee Wah Tsang, Mark J Arends, Elizabeth J Soilleux

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

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 IgA tTG and haemoglobin (Hb) data improves the inter-observer 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 one, 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 two, 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 inter-observer agreement in CD diagnosis using digitised WSIs, even after the inclusion of IgA tTG and Hb data, indicates the important 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 AI.
Original languageEnglish
JournalBMJ open gastroenterology
Early online date1 Feb 2024
Publication statusE-pub ahead of print - 1 Feb 2024


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