Virchows Archiv

, Volume 475, Issue 5, pp 573–578 | Cite as

Effects of subspecialty signout and group consensus on the diagnosis of microscopic colitis

  • Meenal Sharma
  • Christa L. Whitney-Miller
  • Michael G. Drage
  • Aaron R. Huber
  • Raul S. GonzalezEmail author
Original Article


Microscopic colitis (MC) includes lymphocytic colitis (LC) and collagenous colitis (CC). Microscopic changes are required to establish these diagnoses. While criteria exist, interobserver variability has been reported previously. This has not been evaluated in the context of subspecialty signout (SSSO) or a consensus conference. We identified 133 colon biopsies diagnosed as LC, CC, MC, or normal but with mild changes insufficient for MC. All predated the introduction of SSSO at our institution. They were independently reviewed by three gastrointestinal (GI) pathologists. Cases lacking independent consensus were reviewed by the same pathologists in consensus conference to establish a final diagnosis. Individual diagnoses were compared with the consensus diagnoses, and consensus diagnoses were compared with original diagnoses made by GI and non-GI pathologists. Consensus diagnoses were normal (n = 34), LC (n = 57), and CC (n = 42). “Normal” was the diagnosis most commonly agreed upon independently (27/34 cases, P = 0.0073 versus LC, P = 0.0172 versus CC). The reviewing pathologists independently agreed with 80%, 80%, and 94% of consensus diagnoses (κ = 0.70, 0.69, and 0.91). The group consensus agreed with the diagnoses in 49 of 58 (84%) cases originally signed out by non-GI pathologists (κ = 0.77) and in 44 of 57 (77%) cases originally signed out by GI pathologists (κ = 0.63). Good interobserver agreement exists for MC, though whether GI subspecialty training improves agreement remains unclear. Group consensus may aid in diagnosis of difficult/borderline MC cases.


Microscopic colitis Lymphocytic colitis Collagenous colitis Interobserver variability Subspecialty signout 



MS screened the slides, collected data, and co-wrote the manuscript. CLW, MGD, and ARH performed independent and consensus review of the slides. RSG designed the study, screened selected slides, analyzed the data, and co-wrote the manuscript.

Compliance with ethical standards

This research was performed with appropriate Institutional Research Board approval. Human participants were not recruited. A waiver of HIPAA authorization was obtained.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Bjornbak C, Engel PJ, Nielsen PL, Munck LK (2011) Microscopic colitis: clinical findings, topography and persistence of histopathological subgroups. Aliment Pharmacol Ther 34:1225–1234CrossRefGoogle Scholar
  2. 2.
    Munch A, Aust D, Bohr J et al (2012) Microscopic colitis: current status, present and future challenges: statements of the European Microscopic Colitis Group. J Crohns Colitis 6:932–945CrossRefGoogle Scholar
  3. 3.
    Nyhlin N, Bohr J, Eriksson S, Tysk C (2008) Microscopic colitis: a common and an easily overlooked cause of chronic diarrhoea. Eur J Intern Med 19:181–186CrossRefGoogle Scholar
  4. 4.
    Tangri V, Chande N (2009) Microscopic colitis: an update. J Clin Gastroenterol 43:293–296CrossRefGoogle Scholar
  5. 5.
    Fernández-Bañares F, Casanova MJ, Arguedas Y, Beltrán B, Busquets D, Fernández JM, Fernández-Salazar L, García-Planella E, Guagnozzi D, Lucendo AJ, Manceñido N, Marín-Jiménez I, Montoro M, Piqueras M, Robles V, Ruiz-Cerulla A, Gisbert JP, the Spanish Microscopic Colitis Group (SMCG) (2016) Current concepts on microscopic colitis: evidence-based statements and recommendations of the Spanish Microscopic Colitis Group. Aliment Pharmacol Ther 43:400–426CrossRefGoogle Scholar
  6. 6.
    Lazenby AJ, Yardley JH, Giardiello FM, Jessurun J, Bayless TM (1989) Lymphocytic (“microscopic”) colitis: a comparative histopathologic study with particular reference to collagenous colitis. Hum Pathol 20:18–28CrossRefGoogle Scholar
  7. 7.
    Baert F, Wouters K, D’Haens G et al (1999) Lymphocytic colitis: a distinct clinical entity? A clinicopathological confrontation of lymphocytic and collagenous colitis. Gut 45:375–381CrossRefGoogle Scholar
  8. 8.
    Langner C, Aust D, Ensari A, Villanacci V, Becheanu G, Miehlke S, Geboes K, Münch A, the Working Group of Digestive Diseases of the European Society of Pathology (ESP) and the European Microscopic Colitis Group (EMCG) (2015) Histology of microscopic colitis-review with a practical approach for pathologists. Histopathology 66:613–626CrossRefGoogle Scholar
  9. 9.
    Magro F, Langner C, Driessen A, Ensari A, Geboes K, Mantzaris GJ, Villanacci V, Becheanu G, Nunes PB, Cathomas G, Fries W, Jouret-Mourin A, Mescoli C, de Petris G, Rubio CA, Shepherd NA, Vieth M, Eliakim R (2013) European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis 7:827–851CrossRefGoogle Scholar
  10. 10.
    Geboes K (2008) Lymphocytic, collagenous and other microscopic colitides: pathology and the relationship with idiopathic inflammatory bowel diseases. Gastroenterol Clin Biol 32:689–694CrossRefGoogle Scholar
  11. 11.
    Guagnozzi D, Landolfi S, Vicario M (2016) Towards a new paradigm of microscopic colitis: incomplete and variant forms. World J Gastroenterol 22:8459–8471CrossRefGoogle Scholar
  12. 12.
    Limsui D, Pardi DS, Smyrk TC, Abraham SC, Lewis JT, Sanderson SO, Kammer PP, Dierkhising RA, Zinsmeister AR (2009) Observer variability in the histologic diagnosis of microscopic colitis. Inflamm Bowel Dis 15:35–38CrossRefGoogle Scholar
  13. 13.
    Fiehn AM, Bjørnbak C, Warnecke M, Engel PJ, Munck LK (2013) Observer variability in the histopathologic diagnosis of microscopic colitis and subgroups. Hum Pathol 44:2461–2466CrossRefGoogle Scholar
  14. 14.
    Olesen M, Eriksson S, Bohr J, Järnerot G, Tysk C (2004) Microscopic colitis: a common diarrheal disease. An epidemiological study in Orebro, Sweden, 1993-1998. Gut 53:346–350CrossRefGoogle Scholar
  15. 15.
    Vigren L, Olesen M, Benoni C, Sjöberg K (2012) Are collagenous and lymphocytic colitis different aspects of the same disease? Scand J Gastroenterol 47:1448–1453CrossRefGoogle Scholar
  16. 16.
    Milner DA Jr, Meserve EEK, Rinda Soong T, Mata DA (2017) Statistics for pathologists. Demos Medical, New York, pp 83–84Google Scholar
  17. 17.
    Fernandez-Banares F, Salas A, Esteve M (2008) Pitfalls and errors in the diagnosis of collagenous and lymphocytic colitis. J Crohns Colitis 2:343–347CrossRefGoogle Scholar
  18. 18.
    Salas A, Fernandez-Banares F, Casalots J, Gonzalez C, Tarroch X, Forcada P, Gonzalez G (2003) Subepithelial myofibroblasts and tenascin expression in microscopic colitis. Histopathology 43:48–54CrossRefGoogle Scholar
  19. 19.
    Anagnostopoulos I, Schuppan D, Riecken EO, Gross UM, Stein H (1999) Tenascin labelling in colorectal biopsies: a useful marker in the diagnosis of collagenous colitis. Histopathology 34:425–431CrossRefGoogle Scholar
  20. 20.
    Mohamed N, Marais M, Bezuidenhout J (2011) Microscopic colitis as a missed cause of chronic diarrhea. World J Gastroenterol 17:1996–2002CrossRefGoogle Scholar
  21. 21.
    Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S (2008) Diagnosis and management of microscopic colitis. World J Gastroenterol 14:7280–7288CrossRefGoogle Scholar
  22. 22.
    Sarewitz SJ (2014) Subspecialization in community pathology practice. Arch Pathol Lab Med 138:871–872CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pathology and Laboratory MedicineUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Department of PathologyBeth Israel Deaconess Medical CenterBostonUSA

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