Number of intraepithelial lymphocytes and presence of a subepithelial band in normal colonic mucosa differs according to stainings and evaluation method
Chronic watery diarrhea is a frequent symptom. In approximately 10% of the patients, a diagnosis of microscopic colitis (MC) is established. The diagnosis relies on specific, but sometimes subtle, histopathological findings. As the histology of normal intestinal mucosa vary, discriminating subtle fe...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-12-01
|
| Series: | Journal of Pathology Informatics |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2153353924000130 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850109364670562304 |
|---|---|
| author | Anne-Marie Kanstrup Fiehn Peter Johan Heiberg Engel Ulla Engel Dea Natalie Munch Jepsen Thomas Blixt Julie Rasmussen Signe Wildt Wojciech Cebula Andreea-Raluca Diac Lars Kristian Munck |
| author_facet | Anne-Marie Kanstrup Fiehn Peter Johan Heiberg Engel Ulla Engel Dea Natalie Munch Jepsen Thomas Blixt Julie Rasmussen Signe Wildt Wojciech Cebula Andreea-Raluca Diac Lars Kristian Munck |
| author_sort | Anne-Marie Kanstrup Fiehn |
| collection | DOAJ |
| description | Chronic watery diarrhea is a frequent symptom. In approximately 10% of the patients, a diagnosis of microscopic colitis (MC) is established. The diagnosis relies on specific, but sometimes subtle, histopathological findings. As the histology of normal intestinal mucosa vary, discriminating subtle features of MC from normal tissue can be challenging and therefore auxiliary stainings are increasingly used. The aim of this study was to determine the variance in number of intraepithelial lymphocytes (IELs) and presence of a subepithelial band in normal ileum and colonic mucosa, according to different stains and digital assessment. Sixty-one patients without diarrhea referred to screening colonoscopy due to a positive feacal blood test and presenting with endoscopically normal mucosa were included. Basic histological features, number of IELs, and thickness of a subepithelial band was manually evaluated and a deep learning-based algorithm was developed to digitally determine the number of IELs in each of the two compartments; surface epithelium and cryptal epithelium, and the density of lymphocytes in the lamina propria compartment. The number of IELs was significantly higher on CD3-stained slides compared with slides stained with Hematoxylin-and-Eosin (HE) (p<0.001), and even higher numbers were reached using digital analysis. No significant difference between right and left colon in IELs or density of CD3-positive lymphocytes in lamina propria was found. No subepithelial band was present in HE-stained slides while a thin band was visualized on special stains. Conclusively, in this cohort of prospectively collected ileum and colonic biopsies from asymptomatic patients, the range of IELs and detection of a subepithelial collagenous band varied depending on the stain and method used for assessment. As assessment of biopsies from patients with diarrhea constitute a considerable workload in the pathology departments digital image analysis is highly desired. Knowledge provided by the present study highlight important differences that should be considered before introducing this method in the clinic. |
| format | Article |
| id | doaj-art-8e783877457345e58927c84ae548a4fd |
| institution | OA Journals |
| issn | 2153-3539 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pathology Informatics |
| spelling | doaj-art-8e783877457345e58927c84ae548a4fd2025-08-20T02:38:05ZengElsevierJournal of Pathology Informatics2153-35392024-12-011510037410.1016/j.jpi.2024.100374Number of intraepithelial lymphocytes and presence of a subepithelial band in normal colonic mucosa differs according to stainings and evaluation methodAnne-Marie Kanstrup Fiehn0Peter Johan Heiberg Engel1Ulla Engel2Dea Natalie Munch Jepsen3Thomas Blixt4Julie Rasmussen5Signe Wildt6Wojciech Cebula7Andreea-Raluca Diac8Lars Kristian Munck9Department of Pathology, Zealand University Hospital Roskilde, Sygehusvej 9, 4000 Roskilde, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Corresponding author at: Department of Pathology and Department of Surgery, Zealand University Hospital, Roskilde, Sygehusvej 9, 4000 Roskilde, Denmark.Department of Pathology, Zealand University Hospital Roskilde, Sygehusvej 9, 4000 Roskilde, DenmarkDepartment of Pathology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, DenmarkDepartment of Pathology, Zealand University Hospital Roskilde, Sygehusvej 9, 4000 Roskilde, Denmark; Center for Surgical Science, Zealand University Hospital Køge, Lykkebækvej 1, 4600 Køge, DenmarkDepartment of Medical Gastroenterology, Zealand University Hospital Køge, Lykkebækvej 1, 4600 Køge, DenmarkDepartment of Medical Gastroenterology, Zealand University Hospital Køge, Lykkebækvej 1, 4600 Køge, DenmarkGastroUnit, Department of Medical Gastroenterology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, DenmarkDepartment of Medical Gastroenterology, Zealand University Hospital Nykøbing Falster, Fjordvej 15, 4800 Nykøbing Falster, DenmarkDepartment of Medical Gastroenterology, Zealand University Hospital Nykøbing Falster, Fjordvej 15, 4800 Nykøbing Falster, DenmarkDepartment of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Department of Medical Gastroenterology, Zealand University Hospital Køge, Lykkebækvej 1, 4600 Køge, DenmarkChronic watery diarrhea is a frequent symptom. In approximately 10% of the patients, a diagnosis of microscopic colitis (MC) is established. The diagnosis relies on specific, but sometimes subtle, histopathological findings. As the histology of normal intestinal mucosa vary, discriminating subtle features of MC from normal tissue can be challenging and therefore auxiliary stainings are increasingly used. The aim of this study was to determine the variance in number of intraepithelial lymphocytes (IELs) and presence of a subepithelial band in normal ileum and colonic mucosa, according to different stains and digital assessment. Sixty-one patients without diarrhea referred to screening colonoscopy due to a positive feacal blood test and presenting with endoscopically normal mucosa were included. Basic histological features, number of IELs, and thickness of a subepithelial band was manually evaluated and a deep learning-based algorithm was developed to digitally determine the number of IELs in each of the two compartments; surface epithelium and cryptal epithelium, and the density of lymphocytes in the lamina propria compartment. The number of IELs was significantly higher on CD3-stained slides compared with slides stained with Hematoxylin-and-Eosin (HE) (p<0.001), and even higher numbers were reached using digital analysis. No significant difference between right and left colon in IELs or density of CD3-positive lymphocytes in lamina propria was found. No subepithelial band was present in HE-stained slides while a thin band was visualized on special stains. Conclusively, in this cohort of prospectively collected ileum and colonic biopsies from asymptomatic patients, the range of IELs and detection of a subepithelial collagenous band varied depending on the stain and method used for assessment. As assessment of biopsies from patients with diarrhea constitute a considerable workload in the pathology departments digital image analysis is highly desired. Knowledge provided by the present study highlight important differences that should be considered before introducing this method in the clinic.http://www.sciencedirect.com/science/article/pii/S2153353924000130Normal histologyHistopathologyIntestinal mucosaMicroscopic colitisImmunohistochemical stainingDigital pathology |
| spellingShingle | Anne-Marie Kanstrup Fiehn Peter Johan Heiberg Engel Ulla Engel Dea Natalie Munch Jepsen Thomas Blixt Julie Rasmussen Signe Wildt Wojciech Cebula Andreea-Raluca Diac Lars Kristian Munck Number of intraepithelial lymphocytes and presence of a subepithelial band in normal colonic mucosa differs according to stainings and evaluation method Journal of Pathology Informatics Normal histology Histopathology Intestinal mucosa Microscopic colitis Immunohistochemical staining Digital pathology |
| title | Number of intraepithelial lymphocytes and presence of a subepithelial band in normal colonic mucosa differs according to stainings and evaluation method |
| title_full | Number of intraepithelial lymphocytes and presence of a subepithelial band in normal colonic mucosa differs according to stainings and evaluation method |
| title_fullStr | Number of intraepithelial lymphocytes and presence of a subepithelial band in normal colonic mucosa differs according to stainings and evaluation method |
| title_full_unstemmed | Number of intraepithelial lymphocytes and presence of a subepithelial band in normal colonic mucosa differs according to stainings and evaluation method |
| title_short | Number of intraepithelial lymphocytes and presence of a subepithelial band in normal colonic mucosa differs according to stainings and evaluation method |
| title_sort | number of intraepithelial lymphocytes and presence of a subepithelial band in normal colonic mucosa differs according to stainings and evaluation method |
| topic | Normal histology Histopathology Intestinal mucosa Microscopic colitis Immunohistochemical staining Digital pathology |
| url | http://www.sciencedirect.com/science/article/pii/S2153353924000130 |
| work_keys_str_mv | AT annemariekanstrupfiehn numberofintraepitheliallymphocytesandpresenceofasubepithelialbandinnormalcolonicmucosadiffersaccordingtostainingsandevaluationmethod AT peterjohanheibergengel numberofintraepitheliallymphocytesandpresenceofasubepithelialbandinnormalcolonicmucosadiffersaccordingtostainingsandevaluationmethod AT ullaengel numberofintraepitheliallymphocytesandpresenceofasubepithelialbandinnormalcolonicmucosadiffersaccordingtostainingsandevaluationmethod AT deanataliemunchjepsen numberofintraepitheliallymphocytesandpresenceofasubepithelialbandinnormalcolonicmucosadiffersaccordingtostainingsandevaluationmethod AT thomasblixt numberofintraepitheliallymphocytesandpresenceofasubepithelialbandinnormalcolonicmucosadiffersaccordingtostainingsandevaluationmethod AT julierasmussen numberofintraepitheliallymphocytesandpresenceofasubepithelialbandinnormalcolonicmucosadiffersaccordingtostainingsandevaluationmethod AT signewildt numberofintraepitheliallymphocytesandpresenceofasubepithelialbandinnormalcolonicmucosadiffersaccordingtostainingsandevaluationmethod AT wojciechcebula numberofintraepitheliallymphocytesandpresenceofasubepithelialbandinnormalcolonicmucosadiffersaccordingtostainingsandevaluationmethod AT andreearalucadiac numberofintraepitheliallymphocytesandpresenceofasubepithelialbandinnormalcolonicmucosadiffersaccordingtostainingsandevaluationmethod AT larskristianmunck numberofintraepitheliallymphocytesandpresenceofasubepithelialbandinnormalcolonicmucosadiffersaccordingtostainingsandevaluationmethod |