Peer-reviewed veterinary case report
How tissue processing affects intestinal biopsy results in dogs and
By Willard, M D et al.·Published in Journal of veterinary internal medicine·2010·Department of Small Animal Clinical Sciences, United States·View original on PubMed →
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Original publication title: Effect of tissue processing on assessment of endoscopic intestinal biopsies in dogs and cats.
Plain-English summary
This study looked at how well different pathologists agree on interpreting intestinal tissue samples from dogs and cats, especially in cases where pets had low protein levels in their blood (hypoalbuminemia). The researchers examined samples from 62 dogs and 25 cats and found that there was a lot of disagreement among the pathologists about the severity of the lesions, which are changes in the tissue. They discovered that using simpler grading scales helped improve agreement among the pathologists, but inconsistencies still existed due to how the samples were processed. Importantly, they found a significant link between a specific type of tissue change (lacteal dilation) and low protein levels, suggesting that this could be an important factor for veterinarians to consider. Overall, while some patterns were identified, the study highlighted that pathologists still struggle to agree on the interpretation of these samples.
Abstract
BACKGROUND: Prior studies failed to detect significant association between hypoalbuminemia and small intestinal lesions. HYPOTHESIS: Use of pictorial templates will enhance consistency of interpathologist interpretation and identification of intestinal lesions associated with hypoalbuminemia. ANIMALS: Tissues from 62 dogs and 25 cats examined as clinical cases at 7 referral veterinary practices in 4 countries. METHODS: Retrospective, observational study. Histopathology slides from sequential cases undergoing endoscopic biopsy were examined by 4 pathologists by pictorial templates. Changes for 9 microscopic features were recorded as normal, mild, moderate or severe, and 2- and 4-point scales were tested for consistency of interpretation. Logistic regression models determined odds ratios (OR) of histologic lesions being associated with hypoalbuminemia while kappa statistics determined agreement between pathologists on histologic lesions. RESULTS: There was poor agreement (kappa = -0.013 to 0.3) between pathologists, and institution of origin of slides had effect (kappa = 1.0 for 3 of 4 lesions on slides from Institution 5) on agreement between pathologists on selected histologic features. Using 2 point as opposed to 4-point grading scale increased agreement between pathologists (maximum kappa = 0.69 using 4-point scale versus maximum kappa = 1.0 using 2-point scale). Significant association (P = .019- .04; 95% OR = 3.14-10.84) between lacteal dilation and hypoalbuminemia was found by 3 pathologists. CONCLUSIONS AND CLINICAL IMPORTANCE: Substantial inconsistency between pathologists remains despite use of pictorial template because of differences in slide processing. Distinguishing between mild and moderate lesions might be important source of the disagreement among pathologists.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/20002551/