CONTEXT: - Graft-versus-host disease of the gastrointestinal tract is a common complication of hematopoietic stem cell transplant associated with significant morbidity and mortality. Accurate diagnosis can be difficult and is a truly clinicopathologic endeavor. OBJECTIVES: - To assess the diagnostic sensitivity of gastrointestinal graft-versus-host disease using the 2015 National Institutes of Health (NIH) histology consensus guidelines and to analyze histologic findings that support the guidelines. DESIGN: - Patients with allogeneic hematopoietic stem cell transplants were identified via a retrospective search of our electronic medical records from January 1, 2005, to January 1, 2011. Endoscopies with available histology were reviewed by 2 pathologists using the 2015 NIH guidelines. The clinical diagnosis was used as the gold standard. A nontransplant set of endoscopic biopsies was used as a control. RESULTS: - Of the 250 total endoscopies, 217 (87%) had a clinical diagnosis of gastrointestinal graft-versus-host disease. Use of the NIH consensus guidelines showed a sensitivity of 86% and a specificity of 65%. Thirty-seven of 58 (64%) cases with an initial false-negative histopathologic diagnosis were diagnosed as graft-versus-host disease on our review. CONCLUSIONS: - Use of the NIH histology consensus guidelines results in a high sensitivity and specificity, thereby decreasing false-negatives. Additionally, use of the NIH guidelines aids in creating uniformity and diagnostic clarity. Correlation with clinical and laboratory findings is critical in evaluating the differential diagnosis and to avoid false-positives. As expected, increased apoptosis with decreased inflammation was associated with a pathologic diagnosis of graft-versus-host disease and supports the NIH guidelines.
CONTEXT: - Graft-versus-host disease of the gastrointestinal tract is a common complication of hematopoietic stem cell transplant associated with significant morbidity and mortality. Accurate diagnosis can be difficult and is a truly clinicopathologic endeavor. OBJECTIVES: - To assess the diagnostic sensitivity of gastrointestinal graft-versus-host disease using the 2015 National Institutes of Health (NIH) histology consensus guidelines and to analyze histologic findings that support the guidelines. DESIGN: - Patients with allogeneic hematopoietic stem cell transplants were identified via a retrospective search of our electronic medical records from January 1, 2005, to January 1, 2011. Endoscopies with available histology were reviewed by 2 pathologists using the 2015 NIH guidelines. The clinical diagnosis was used as the gold standard. A nontransplant set of endoscopic biopsies was used as a control. RESULTS: - Of the 250 total endoscopies, 217 (87%) had a clinical diagnosis of gastrointestinal graft-versus-host disease. Use of the NIH consensus guidelines showed a sensitivity of 86% and a specificity of 65%. Thirty-seven of 58 (64%) cases with an initial false-negative histopathologic diagnosis were diagnosed as graft-versus-host disease on our review. CONCLUSIONS: - Use of the NIH histology consensus guidelines results in a high sensitivity and specificity, thereby decreasing false-negatives. Additionally, use of the NIH guidelines aids in creating uniformity and diagnostic clarity. Correlation with clinical and laboratory findings is critical in evaluating the differential diagnosis and to avoid false-positives. As expected, increased apoptosis with decreased inflammation was associated with a pathologic diagnosis of graft-versus-host disease and supports the NIH guidelines.
Authors: J C Papadimitriou; C B Drachenberg; C O Beskow; C Cangro; A Wiland; D Klassen; M Weir; S Bartlett Journal: Transplant Proc Date: 2001-05 Impact factor: 1.066
Authors: Madan Jagasia; Mukta Arora; Mary E D Flowers; Nelson J Chao; Philip L McCarthy; Corey S Cutler; Alvaro Urbano-Ispizua; Steven Z Pavletic; Michael D Haagenson; Mei-Jie Zhang; Joseph H Antin; Brian J Bolwell; Christopher Bredeson; Jean-Yves Cahn; Mitchell Cairo; Robert Peter Gale; Vikas Gupta; Stephanie J Lee; Mark Litzow; Daniel J Weisdorf; Mary M Horowitz; Theresa Hahn Journal: Blood Date: 2011-10-18 Impact factor: 22.113
Authors: Madan H Jagasia; Hildegard T Greinix; Mukta Arora; Kirsten M Williams; Daniel Wolff; Edward W Cowen; Jeanne Palmer; Daniel Weisdorf; Nathaniel S Treister; Guang-Shing Cheng; Holly Kerr; Pamela Stratton; Rafael F Duarte; George B McDonald; Yoshihiro Inamoto; Afonso Vigorito; Sally Arai; Manuel B Datiles; David Jacobsohn; Theo Heller; Carrie L Kitko; Sandra A Mitchell; Paul J Martin; Howard Shulman; Roy S Wu; Corey S Cutler; Georgia B Vogelsang; Stephanie J Lee; Steven Z Pavletic; Mary E D Flowers Journal: Biol Blood Marrow Transplant Date: 2014-12-18 Impact factor: 5.742
Authors: Howard M Shulman; Diana M Cardona; Joel K Greenson; Sangeeta Hingorani; Thomas Horn; Elisabeth Huber; Andreas Kreft; Thomas Longerich; Thomas Morton; David Myerson; Victor G Prieto; Avi Rosenberg; Nathaniel Treister; Kay Washington; Mirjana Ziemer; Steven Z Pavletic; Stephanie J Lee; Mary E D Flowers; Kirk R Schultz; Madan Jagasia; Paul J Martin; Georgia B Vogelsang; David E Kleiner Journal: Biol Blood Marrow Transplant Date: 2015-01-29 Impact factor: 5.742
Authors: William A Ross; Shubhra Ghosh; Alexander A Dekovich; Suyu Liu; Gregory D Ayers; Karen R Cleary; Jeffrey H Lee; Daniel Couriel Journal: Am J Gastroenterol Date: 2007-11-19 Impact factor: 10.864
Authors: P H Baehr; D S Levine; M E Bouvier; D M Hockenbery; T A Gooley; J G Stern; P J Martin; G B McDonald Journal: Transplantation Date: 1995-12-15 Impact factor: 4.939