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ABSTRACT: Background: In the investigations of dogs with chronic small intestinal diarrhea collection of ileal biopsies lengthens procedural time and has been of uncertain value.Objectives: To evaluate whether there was agreement between histologic changes present in samples of duodenal and ileal mucosa, and hence to provide initial information in the process of determining whether collection of ileal biopsies is clinically justified.Animals: 40 dogs with chronic small and large intestinal diarrhea from which endoscopic (in 30 cases) or surgical (in 10 cases) duodenal and ileal biopsies had been collected.Methods: Samples were reviewed concurrently by two observers (MJD and MDW) using the scoring system developed by the World Small Animal Veterinary Association (WSAVA) Gastrointestinal Standardization Group. Comparisons were made by kappa analysis.Results: Microscopic pathology was observed in 30 cases. Only eight out of this 30 (27%) had the same histopathologic diagnosis in both the duodenum and the ileum. This dropped to 3 out of 30 (10%) if different disease severity was also considered as disagreement. Microscopic pathology would have been found in 60% and 80% of the 30 cases, if only duodenal or ileal biopsies respectively, had been available.Conclusions and clinical importance: There was poor agreement between histopathological findings from duodenal versus ileal biopsies with abnormalities sometimes being more readily detected in the ileum. Routine collection of ileal plus duodenal samples appears warranted when concurrent small and large intestinal diarrhea is present.
Journal of Veterinary Internal Medicine 12/2009; 24(1):80 - 83. · 1.99 Impact Factor
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M.D. Willard,
G.E. Moore,
B.D. Denton,
M.J. Day,
J. Mansell,
T. Bilzer,
B. Wilcock,
M. Gualtieri,
D. Olivero,
P. Lecoindre,
D.C. Twedt,
M.G. Collett, E.J. Hall,
A.E. Jergens,
J.W. Simpson,
R.W. Else,
R.J. Washabau
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[hide abstract]
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 κ statistics determined agreement between pathologists on histologic lesions.Results: There was poor agreement (κ=−0.013 to 0.3) between pathologists, and institution of origin of slides had effect (κ= 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 κ= 0.69 using 4-point scale versus maximum κ= 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.
Journal of Veterinary Internal Medicine 11/2009; 24(1):84 - 89. · 1.99 Impact Factor
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M D Willard,
G E Moore,
B D Denton,
M J Day,
J Mansell,
T Bilzer,
B Wilcock,
M Gualtieri,
D Olivero,
P Lecoindre,
D C Twedt,
M G Collett, E J Hall,
A E Jergens,
J W Simpson,
R W Else,
R J Washabau
[show abstract]
[hide abstract]
ABSTRACT: Prior studies failed to detect significant association between hypoalbuminemia and small intestinal lesions.
Use of pictorial templates will enhance consistency of interpathologist interpretation and identification of intestinal lesions associated with hypoalbuminemia.
Tissues from 62 dogs and 25 cats examined as clinical cases at 7 referral veterinary practices in 4 countries.
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.
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.
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.
Journal of Veterinary Internal Medicine 11/2009; 24(1):84-9. · 1.99 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: In the investigations of dogs with chronic small intestinal diarrhea collection of ileal biopsies lengthens procedural time and has been of uncertain value.
To evaluate whether there was agreement between histologic changes present in samples of duodenal and ileal mucosa, and hence to provide initial information in the process of determining whether collection of ileal biopsies is clinically justified.
40 dogs with chronic small and large intestinal diarrhea from which endoscopic (in 30 cases) or surgical (in 10 cases) duodenal and ileal biopsies had been collected.
Samples were reviewed concurrently by two observers (MJD and MDW) using the scoring system developed by the World Small Animal Veterinary Association (WSAVA) Gastrointestinal Standardization Group. Comparisons were made by kappa analysis.
Microscopic pathology was observed in 30 cases. Only eight out of this 30 (27%) had the same histopathologic diagnosis in both the duodenum and the ileum. This dropped to 3 out of 30 (10%) if different disease severity was also considered as disagreement. Microscopic pathology would have been found in 60% and 80% of the 30 cases, if only duodenal or ileal biopsies respectively, had been available.
There was poor agreement between histopathological findings from duodenal versus ileal biopsies with abnormalities sometimes being more readily detected in the ileum. Routine collection of ileal plus duodenal samples appears warranted when concurrent small and large intestinal diarrhea is present.
Journal of Veterinary Internal Medicine 11/2009; 24(1):80-3. · 1.99 Impact Factor
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M.D. Willard,
J. Mansell,
G.T. Fosgate,
M. Gualtieri,
D. Olivero,
P. Lecoindre,
D.C. Twedt,
M.G. Collett,
M.J. Day, E.J. Hall,
A.E. Jergens,
J.W. Simpson,
R.W. Else,
R.J. Washabau
[show abstract]
[hide abstract]
ABSTRACT: Background: The quality of histopathology slides of endoscopic biopsies from different laboratories varies, but the effect of biopsy quality on outcome is unknown.Hypothesis: The ability to demonstrate a histologic lesion in the stomach or duodenum of a dog or cat is affected by the quality of endoscopic biopsy samples submitted. More endoscopic samples are needed to find a lesion in poor-quality tissue specimens.Animals: Tissues from 99 dogs and 51 cats were examined as clinical cases at 8 veterinary institutions or practices in 5 countries.Methods: Histopathology slides from sequential cases that underwent endoscopic biopsy were submitted by participating institutions. Quality of the histologic section of tissue (inadequate, marginal, adequate), type of lesion (lymphangiectasia, crypt lesion, villus blunting, cellular infiltrate), and severity of lesion (normal, mild, moderate, severe) were determined. Sensitivity of different quality tissue samples for finding different lesions was determined.Results: Fewer samples were required from dogs for diagnosis as the quality of the sample improved from inadequate to marginal to adequate. Duodenal lesions in cats displayed the same trend except for moderate duodenal infiltrates for which quality of tissue sample made no difference. Gastric lesions in dogs and mild gastric lesions in cats had the same trend, whereas the number of tissue samples needed to diagnose moderately severe gastric lesions in cats was not affected by the quality of tissue sample.Conclusions and Clinical Importance: The quality of endoscopically obtained tissue samples has a profound effect on their sensitivity for identifying certain lesions, and there are differences between biopsies of canine and feline tissues.
Journal of Veterinary Internal Medicine 08/2008; 22(5):1084 - 1089. · 1.99 Impact Factor
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ABSTRACT: The characterization of inflammatory change in endoscopic biopsy samples of the gastrointestinal mucosa is an increasingly important component in the diagnosis and management of canine and feline gastrointestinal disease. Interpretation has hitherto been limited by the lack of standard criteria that define morphological and inflammatory features, and the absence of such standardization has made it difficult, if not impossible, to compare results of retrospective or prospective studies. The World Small Animal Veterinary Association (WSAVA) Gastrointestinal Standardization Group was established, in part, to develop endoscopic and microscopical standards in small animal gastroenterology. This monograph presents a standardized pictorial and textual template of the major histopathological changes that occur in inflammatory disease of the canine and feline gastric body, gastric antrum, duodenum and colon. Additionally, a series of standard histopathological reporting forms is proposed, to encourage evaluation of biopsy samples in a systematic fashion. The Standardization Group believes that the international acceptance of these standard templates will advance the study of gastrointestinal disease in individual small companion animals as well as investigations that compare populations of animals.
Journal of Comparative Pathology 138 Suppl 1:S1-43. · 1.65 Impact Factor
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Journal of Veterinary Internal Medicine 24(1):10-26. · 1.99 Impact Factor
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M D Willard,
J Mansell,
G T Fosgate,
M Gualtieri,
D Olivero,
P Lecoindre,
D C Twedt,
M G Collett,
M J Day, E J Hall,
A E Jergens,
J W Simpson,
R W Else,
R J Washabau
[show abstract]
[hide abstract]
ABSTRACT: The quality of histopathology slides of endoscopic biopsies from different laboratories varies, but the effect of biopsy quality on outcome is unknown.
The ability to demonstrate a histologic lesion in the stomach or duodenum of a dog or cat is affected by the quality of endoscopic biopsy samples submitted. More endoscopic samples are needed to find a lesion in poor-quality tissue specimens.
Tissues from 99 dogs and 51 cats were examined as clinical cases at 8 veterinary institutions or practices in 5 countries.
Histopathology slides from sequential cases that underwent endoscopic biopsy were submitted by participating institutions. Quality of the histologic section of tissue (inadequate, marginal, adequate), type of lesion (lymphangiectasia, crypt lesion, villus blunting, cellular infiltrate), and severity of lesion (normal, mild, moderate, severe) were determined. Sensitivity of different quality tissue samples for finding different lesions was determined.
Fewer samples were required from dogs for diagnosis as the quality of the sample improved from inadequate to marginal to adequate. Duodenal lesions in cats displayed the same trend except for moderate duodenal infiltrates for which quality of tissue sample made no difference. Gastric lesions in dogs and mild gastric lesions in cats had the same trend, whereas the number of tissue samples needed to diagnose moderately severe gastric lesions in cats was not affected by the quality of tissue sample.
The quality of endoscopically obtained tissue samples has a profound effect on their sensitivity for identifying certain lesions, and there are differences between biopsies of canine and feline tissues.
Journal of Veterinary Internal Medicine 22(5):1084-9. · 1.99 Impact Factor
