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Journal of Clinical & Experimental Pathology
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Research Article

Automated Image Analysis of Lymphocytes in Lymphocytic Colitis

Peter Johan Heiberg Engel1,2*, Anne-Marie Kanstrup Fiehn1, Martin Kristensson3, Ulla Engel4, Lars Kristian Munck2,5 and Susanne Holck2,4

1Department of Pathology, Roskilde Hospital, Koegevej 7-13, 4000 Roskilde, Denmark

2University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, 2200, Copenhagen, Denmark

3Project Manager, Digital Pathology, Visiopharm, Agern Alle 3, 2970 Hoersholm, Denmark

4Department of Pathology, Copenhagen University Hospital, Hvidovre, Kettegaards Allé 30, 2650 Hvidovre, Denmark

5Department of Gastroenterology, Koege Hospital, Lykkebækvej 1, 4600 Koege, Denmark

*Corresponding Author:
Peter Johan Heiberg Engel
Department of Pathology, Roskilde Hospital
Koegevej 7-13, 4000 Roskilde, Denmark
Fax: +45 46352983
Tel: +45 47325905
E-mail: [email protected]

Received Date: December 08, 2015 Accepted Date: December 15, 2015 Published Date: December 20, 2015

Citation: Engel PJH, Fiehn AK, Kristensson M, Engel U, Munck LK, et al. (2015) Automated Image Analysis of Lymphocytes in Lymphocytic Colitis. J Clin Exp Pathol 5:261. doi: 10.4172/2161-0681.1000261

Copyright: © 2015, Engel PJH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background and aims: The diagnosis of microscopic colitis (MC) rests on a triad of clinical symptoms, a normal endoscopy and characteristic histopathological findings, among which the number of intraepithelial lymphocytes (IELs) is a determining histopathological factor in diagnosing lymphocytic colitis (LC). When the surface epithelium in a HE stained slide shows a largely increased number of IELs, the diagnosis of LC is easy. However, diagnosing incomplete lymphocytic colitis (LCi) may be difficult as mitotic-and/or apoptotic figures can be hard to rule out. The same goes for distinguishing LCi from LC. The purpose of this study was to address such diagnostic challenges by developing software to count immunostained (CD3) T-lymphocytes of colon biopsies in order to facilitate diagnostics of LC and LCi.

Methods and results: Software for automated image analysis (AIA) was developed using a training set of 10 colon biopsies (LC, LCi and normal) to match manual scorings of IELs in the surface epithelium. The study set consisted of blinded biopsies from 59 patients with LC or LCi in which four pathologists individually gave a diagnosis of LC, LCi or normal colon. The result of AIA was correlated to the diagnosis provided by the 4 pathologists. The overall agreement between AIA and the manual scoring was 96.6% (Cohen’s Kappa: 0.858).

Conclusion: AIA is capable of quantifying CD3 stained lymphocytes in colon biopsies and is applicable as a supplementary diagnostic tool in borderline cases of LC and LCi as well as in research on prospective cohort studies.

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