根据在 FFPE 切片上使用抗体检测到的 "久已被遗忘的 "TCRγδ+ 上皮内淋巴细胞，建立一种新的乳糜泻算法。

IF 3.9 2区医学 Q2 CELL BIOLOGY Histopathology Pub Date : 2024-10-07 DOI:10.1111/his.15330

Eda N Kozan, Bilge A Kırmızı, Ceyda T Kirsaclioglu, Derya Gokmen, Berna Savas, Aydan Kansu, Arif I Soykan, Arzu Ensari

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引用次数: 0

摘要

目的：对所有相关方而言，诊断伴有轻微粘膜变化的乳糜泻（CD）都很困难。我们旨在利用一种新型单克隆抗体确定 T 细胞受体（TCR）γδ+ 上皮内淋巴细胞（IELs）在区分 CD 和其他原因引起的上皮内淋巴细胞增多方面的作用：根据临床、血清学和组织学数据将 167 例病例归类为乳糜泻组（117 例未经治疗的 CD，根据 Marsh 分类，由 Ensari 更新，包括 29 例 1 型、29 例 2 型、39 例 3 型和 20 例经治疗的 CD）和非乳糜泻组（24 例对照组和 26 例非乳糜泻 IELosis），使用血色素和伊红、CD3、TCR δ 染料对每 100 个肠细胞中的 IEL 计数进行研究：结果：与非 CD（6.72 ± 6.32）相比，CD（24.83 ± 16.13）中的 TCRγδ+ IELs 明显较高，且与粘膜损伤程度相关。γδ+IEL计数和比值在区分未经治疗的乳糜泻患者和对照组方面均表现出较高的性能，敏感性分别为83.76；85.57，特异性分别为95.83；79.17。TCRγδ+ IEL计数可区分1型CD（20.41 ± 13.57）和非糜烂性IEL病（9.42 ± 7.28）（p = 0.025）。判别分析显示，绒毛/室管膜比值、γδ+和CD3+ IEL计数、γδ+/CD3+IEL比值、IEL分布模式是有效的判别因素，正确分类了82.3%的病例，而算法准确诊断了93.4%的病例：结论：在FFPE切片中检测γδ+ IELs的新抗体显示，γδ+ IELs的阈值为10.5，γδ+/CD3+IEL比值为14%，该抗体能以高灵敏度和特异性区分乳糜泻患者和非乳糜泻患者，特别是在绒毛/隐窝轴正常的病例中，包括1型CD、非CD IELosis和对照组。根据γδ+ IELs提出了一种 "乳糜泻算法"，希望病理学界能将其用于组织病理学诊断方法。

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A new algorithm for coeliac disease based on the 'long forgotten' TCRγδ⁺ intra-epithelial lymphocytes detected with an antibody working on FFPE sections.

Aims: Diagnosis of coeliac disease (CD) with mild mucosal changes is difficult for all parties involved. We aimed to determine the power of T cell receptor (TCR)γδ⁺ intra-epithelial lymphocytes (IELs) in discriminating CD from other causes of intra-epithelial lymphocytosis using a new monoclonal antibody.

Methods: A total of 167 cases categorised as coeliac (117 untreated CD, classified according to Marsh, updated by Ensari, including 29 type 1, 29 type 2, 39 type 3 and 20 treated CD), and non-coeliac groups (24 controls and 26 non-coeliac IELosis) based on clinical, serological and histological data were studied for IEL counts enumerated per 100 enterocytes using haematoxylin and eosin, CD3, TCR δ-stains.

Results: TCRγδ⁺ IELs were significantly higher in CD (24.83 ± 16.13) compared to non-CD (6.72 ± 6.32) and were correlated with the degree of mucosal damage. Both γδ⁺ IEL count and ratio showed higher performance in differentiating untreated coeliacs from controls, with a sensitivity of 83.76; 85.57 and specificity of 95.83; 79.17, respectively. TCRγδ⁺ IEL counts distinguished type 1 CD (20.41 ± 13.57) from non-coeliac IELosis (9.42 ± 7.28) (p = 0.025). Discriminant analysis revealed that villus/crypt ratio, γδ⁺ and CD3⁺ IEL counts, γδ⁺/CD3⁺IEL ratio, IEL distribution pattern were potent discriminants and correctly classified 82.3% of cases while the algorithm accurately diagnosed 93.4% of cases.

Conclusions: The new antibody detecting γδ⁺ IELs in FFPE sections revealed thresholds of 10.5 for γδ⁺ IELs and 14% for γδ⁺/CD3⁺IEL ratio which distinguished coeliacs from non-coeliacs with high sensitivity and specificity, particularly in cases with normal villus/crypt axis including type 1 CD, non-CD IELosis and controls. A 'coeliac algorithm' based on γδ⁺ IELs is proposed with the hope that it will be used in the histopathological diagnostic approach by the pathology community.

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来源期刊

Histopathology 医学-病理学

CiteScore

10.20

自引率

4.70%

发文量

239

审稿时长

1 months

期刊介绍： Histopathology is an international journal intended to be of practical value to surgical and diagnostic histopathologists, and to investigators of human disease who employ histopathological methods. Our primary purpose is to publish advances in pathology, in particular those applicable to clinical practice and contributing to the better understanding of human disease.