The Diagnostic Yield of Site and Symptom-Based Biopsies for Acute Gastrointestinal Graft-Versus-Host Disease: A 5-Year Retrospective Review
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Graft-versus-host disease (GVHD) complicates half of hematopoietic stem cell transplants (HCT), and the gastrointestinal tract is commonly affected. Endoscopic biopsies have a key role in the diagnosis. The optimal procedure(s) to perform and site(s) to biopsy remain unclear.
We retrospectively analyzed the charts of all adult patients who underwent allogeneic HCT at Duke University Medical Center between 1/1/05 and 1/1/11 and extracted data from those who underwent endoscopic biopsy for suspected GVHD. All histology was re-evaluated by blinded pathologists using 2006 NIH diagnostic criteria and then compared to the original clinical diagnosis of GVHD.
A total of 169 adult patients underwent 250 endoscopic procedures to evaluate GVHD. The sensitivity of biopsies for clinical GVHD was 76 and 72 % for upper and lower tract sites, respectively. In the presence of nausea, upper tract biopsies were positive for GVHD in 65 %, 70 % while lower tract biopsies were positive in 61–70 %. In the presence of diarrhea, lower tract biopsies were positive in 65 %, while upper tract sites were positive in 64–69 %. Twenty six (40 %) of the sixty-five endoscopies that simultaneously sampled upper and lower tract sites had discordant results. All were histologically positive for GVHD, yet 15 % of upper tract biopsies and 25 % of lower tract biopsies were negative.
In this large review, the overall sensitivity of biopsies taken during EGD and Flex-Sig was 76 and 72 %, respectively. A symptom-driven biopsy approach was not clearly supported as upper tract and lower tract biopsies were similarly diagnostic for GVHD regardless of symptoms.
KeywordsGraft-versus-host disease Hematopoietic stem cell transplant Endoscopic biopsies Histology
We gratefully acknowledge the efforts of the following additional contributors to this study: Leroy Moriuchi, Kelly Corbet, CJ Paarz-Largay, Matthew Chung, and Zhiguo Li. This paper was supported by the following grants: NIH T32 HL007057-37 (ADS) and the American Society of Hematology Research Training Award for Fellows (ADS).
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Conflict of interest
There are no conflicts of interest for any of the authors.
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