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. 2018 Sep;142(9):1098-1105.
doi: 10.5858/arpa.2017-0054-OA. Epub 2018 Apr 26.

Use of the National Institutes of Health Consensus Guidelines Improves the Diagnostic Sensitivity of Gastrointestinal Graft-Versus-Host Disease

Diana M Cardona, Claire J Detweiler, Michael J Shealy, Anthony D Sung, Daniel M Wild, Martin H Poleski, Bryan L Balmadrid, Constance T Cirrincione, David N Howell, Keith M Sullivan  1
Affiliations

Use of the National Institutes of Health Consensus Guidelines Improves the Diagnostic Sensitivity of Gastrointestinal Graft-Versus-Host Disease

Diana M Cardona et al. Arch Pathol Lab Med. 2018 Sep.

Abstract

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.

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Conflict of interest statement

The authors have no relevant financial interest in the products or companies described in this article.

Figures

Figure 1.
Figure 1.
Photomicrographs of cases diagnosed on review as likely graft-versus-host disease A, Stomach. B, Colon (hematoxylin-eosin, original magnifications ×40 [A] and ×20 [B]).
Figure 2.
Figure 2.
False-positive cases: clinical diagnosis of cytomegalovirus (CMV) and pathologic diagnosis of likely graft-versus-host disease (GVHD) on a duodenum biopsy (A), with negative CMV immunohistochemistry (B), and CMV gastritis and possible GVHD on a stomach biopsy (C), with CMV immunohistochemistry (D). Clostridium difficile infection and mycophenolate mofetil (MMF) toxicity from a rectosigmoid colon biopsy (E) and MMF toxicity from a stomach biopsy (F) (hematoxylin-eosin, original magnification ×20 [A, C, E, and F]; CMV immunohistochemistry, original magnification ×20 [B and D]).
See this image and copyright information in PMC

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