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The histological diagnosis of leprosy type 1 reactions: identification of key variables and an analysis of the process of histological diagnosis

The histological diagnosis of leprosy type 1 reactions: identification of key variables and an analysis of the process of histological diagnosis
The histological diagnosis of leprosy type 1 reactions: identification of key variables and an analysis of the process of histological diagnosis
Background: Type 1 leprosy reactions (T1R) are a major inflammatory complication of leprosy affecting 30% of patients with borderline leprosy, but there has been no diagnostic evaluation of the histological diagnosis of this entity.

Methods: In a prospective study based in India, skin biopsies were taken from 99 patients with clinically diagnosed T1R and 52 non-reactional controls. These were assessed histologically by four histopathologists whose assessments were then compared.

Results: Reactions were under-diagnosed, with 32–62% of clinically diagnosed reactions being given a histological diagnosis. The pathologists showed good specificities (range 72% to 93%) but much poorer sensitivities (range 42% to 78%). The most commonly reported histological features of TIR were cell maturity, oedema and giant cells. Five key variables were identified that the pathologists used in diagnosing a reaction: intra-granuloma oedema, giant cell size, giant cell numbers, dermal oedema and HLA-DR expression. A predictive model for the diagnosis of T1R was developed using stepwise logistic regression analysis, with clinical diagnosis of reaction as an outcome, and then identification of the key variables that each pathologist used in making the diagnosis of T1R. 34–53% of the variation between pathologists could be accounted for. The four pathologists used a similar diagnostic model and for all of them their estimations of epithelioid cell granuloma oedema, dermal oedema, plasma cells and granuloma fraction were significant variables in the diagnosis of T1R. Each pathologist then added in variables that were specific to themselves.

Conclusions: This study has identified T1R as being under-diagnosed in comparison with clinical assessments. Key variables for diagnosing T1R were established. This comparative masked study highlights the need for such studies in other inflammatory conditions.
histological diagnosis, leprosy, skin biopsies
0021-9746
595-600
Lockwood, D.N.J.
075da765-b070-4e35-aa82-84ead70f22f1
Lucas, S.B.
0d44d781-2de4-43d0-95d8-2be7b288de80
Desikan, K.V.
7b73a83d-fac6-4c6b-a502-13dfcc379d2b
Ebenezer, G.
b6241086-592e-416f-98ad-5a83acd40b2b
Suneetha, S.
fbf6e37d-6279-4b54-9ce3-bc6e3e268c64
Nicholls, P.
b806adfb-76d9-4b75-83b1-a1d63e779009
Lockwood, D.N.J.
075da765-b070-4e35-aa82-84ead70f22f1
Lucas, S.B.
0d44d781-2de4-43d0-95d8-2be7b288de80
Desikan, K.V.
7b73a83d-fac6-4c6b-a502-13dfcc379d2b
Ebenezer, G.
b6241086-592e-416f-98ad-5a83acd40b2b
Suneetha, S.
fbf6e37d-6279-4b54-9ce3-bc6e3e268c64
Nicholls, P.
b806adfb-76d9-4b75-83b1-a1d63e779009

Lockwood, D.N.J., Lucas, S.B., Desikan, K.V., Ebenezer, G., Suneetha, S. and Nicholls, P. (2008) The histological diagnosis of leprosy type 1 reactions: identification of key variables and an analysis of the process of histological diagnosis. Journal of Clinical Pathology, 61 (5), 595-600. (doi:10.1136/jcp.2007.053389). (PMID:18326022)

Record type: Article

Abstract

Background: Type 1 leprosy reactions (T1R) are a major inflammatory complication of leprosy affecting 30% of patients with borderline leprosy, but there has been no diagnostic evaluation of the histological diagnosis of this entity.

Methods: In a prospective study based in India, skin biopsies were taken from 99 patients with clinically diagnosed T1R and 52 non-reactional controls. These were assessed histologically by four histopathologists whose assessments were then compared.

Results: Reactions were under-diagnosed, with 32–62% of clinically diagnosed reactions being given a histological diagnosis. The pathologists showed good specificities (range 72% to 93%) but much poorer sensitivities (range 42% to 78%). The most commonly reported histological features of TIR were cell maturity, oedema and giant cells. Five key variables were identified that the pathologists used in diagnosing a reaction: intra-granuloma oedema, giant cell size, giant cell numbers, dermal oedema and HLA-DR expression. A predictive model for the diagnosis of T1R was developed using stepwise logistic regression analysis, with clinical diagnosis of reaction as an outcome, and then identification of the key variables that each pathologist used in making the diagnosis of T1R. 34–53% of the variation between pathologists could be accounted for. The four pathologists used a similar diagnostic model and for all of them their estimations of epithelioid cell granuloma oedema, dermal oedema, plasma cells and granuloma fraction were significant variables in the diagnosis of T1R. Each pathologist then added in variables that were specific to themselves.

Conclusions: This study has identified T1R as being under-diagnosed in comparison with clinical assessments. Key variables for diagnosing T1R were established. This comparative masked study highlights the need for such studies in other inflammatory conditions.

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More information

e-pub ahead of print date: 6 March 2008
Published date: May 2008
Keywords: histological diagnosis, leprosy, skin biopsies

Identifiers

Local EPrints ID: 59024
URI: https://eprints.soton.ac.uk/id/eprint/59024
ISSN: 0021-9746
PURE UUID: 7198b410-e2c0-447a-860f-b6ce776a3b1e

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Date deposited: 21 Aug 2008
Last modified: 13 Mar 2019 20:31

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