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

Publication ,  Journal Article
Cardona, DM; Detweiler, CJ; Shealy, MJ; Sung, AD; Wild, DM; Poleski, MH; Balmadrid, BL; Cirrincione, CT; Howell, DN; Sullivan, KM
Published in: Arch Pathol Lab Med
September 2018

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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Published In

Arch Pathol Lab Med

DOI

EISSN

1543-2165

Publication Date

September 2018

Volume

142

Issue

9

Start / End Page

1098 / 1105

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Practice Guidelines as Topic
  • Pathology
  • National Institutes of Health (U.S.)
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Graft vs Host Disease
  • Gastrointestinal Diseases
  • 3202 Clinical sciences
 

Citation

APA
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MLA
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Cardona, D. M., Detweiler, C. J., Shealy, M. J., Sung, A. D., Wild, D. M., Poleski, M. H., … Sullivan, K. M. (2018). Use of the National Institutes of Health Consensus Guidelines Improves the Diagnostic Sensitivity of Gastrointestinal Graft-Versus-Host Disease. Arch Pathol Lab Med, 142(9), 1098–1105. https://doi.org/10.5858/arpa.2017-0054-OA
Cardona, Diana M., Claire J. Detweiler, Michael J. Shealy, Anthony D. Sung, Daniel M. Wild, Martin H. Poleski, Bryan L. Balmadrid, Constance T. Cirrincione, David N. Howell, and Keith M. Sullivan. “Use of the National Institutes of Health Consensus Guidelines Improves the Diagnostic Sensitivity of Gastrointestinal Graft-Versus-Host Disease.Arch Pathol Lab Med 142, no. 9 (September 2018): 1098–1105. https://doi.org/10.5858/arpa.2017-0054-OA.
Cardona DM, Detweiler CJ, Shealy MJ, Sung AD, Wild DM, Poleski MH, et al. Use of the National Institutes of Health Consensus Guidelines Improves the Diagnostic Sensitivity of Gastrointestinal Graft-Versus-Host Disease. Arch Pathol Lab Med. 2018 Sep;142(9):1098–105.
Cardona, Diana M., et al. “Use of the National Institutes of Health Consensus Guidelines Improves the Diagnostic Sensitivity of Gastrointestinal Graft-Versus-Host Disease.Arch Pathol Lab Med, vol. 142, no. 9, Sept. 2018, pp. 1098–105. Pubmed, doi:10.5858/arpa.2017-0054-OA.
Cardona DM, Detweiler CJ, Shealy MJ, Sung AD, Wild DM, Poleski MH, Balmadrid BL, Cirrincione CT, Howell DN, Sullivan KM. Use of the National Institutes of Health Consensus Guidelines Improves the Diagnostic Sensitivity of Gastrointestinal Graft-Versus-Host Disease. Arch Pathol Lab Med. 2018 Sep;142(9):1098–1105.

Published In

Arch Pathol Lab Med

DOI

EISSN

1543-2165

Publication Date

September 2018

Volume

142

Issue

9

Start / End Page

1098 / 1105

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Practice Guidelines as Topic
  • Pathology
  • National Institutes of Health (U.S.)
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Graft vs Host Disease
  • Gastrointestinal Diseases
  • 3202 Clinical sciences