{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:23:58Z","timestamp":1792038238679,"version":"4.4.0"},"reference-count":60,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:00:00Z","timestamp":1749600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Kings College, University of Cambridge"},{"name":"Pathological Society of Great Britain and Ireland"},{"name":"Coeliac UK Sponsored Dissertation grant"},{"name":"University of Cambridge Department of Pathology PhD grant"},{"name":"Coeliac UK and Innovate UK"},{"name":"NIHR i4i PDA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Understanding the diagnostic landscape is essential prior to developing artificial intelligence (AI)-based diagnostic strategies for automating the diagnosis of duodenal biopsies. This study aims to (1) determine the frequencies of different diagnoses seen in endoscopic duodenal biopsies in a large, tertiary referral centre; (2) identify key words on histopathology request forms that could indicate that a biopsy may contain a serious pathology and should not be diagnosed by an AI system; and (3) investigate the proportion of cases described as showing \u201cintraepithelial lymphocytosis\u201d that might be coeliac disease. Methods: To achieve this, we audited 18 months\u2019 worth of duodenal biopsy reports in our centre. Results: A total of 6245 duodenal biopsies were identified, of which 73.76% were normal and at least 8.84% fell within the spectrum of coeliac disease. Additionally, 6.47% were classified as showing non-specific inflammation, 1.86% were adenomas, 0.45% were carcinomas, 0.06% were neuroendocrine tumours, 0.10% were lymphomas, and 0.03% were cases of flat dysplasia, giving a total of 0.64% of dysplastic or malignant diagnoses. Rarer diagnoses included ulceration, Helicobacter pylori infection, giardiasis, lymphangiectasia, transplant rejection, and lymphoma. Furthermore, 227 biopsies (3.63%) showed isolated intraepithelial lymphocytosis, of which 33 cases (14.5%) gave an overall clinicopathological picture of coeliac disease. Conclusions: We present the first long-term audit of all endoscopic duodenal biopsies received by the histopathology department of a tertiary-care facility. The results indicate that a fully automated diagnostic histopathology reporting system able to identify normal duodenal biopsies and biopsies within the spectrum of coeliac disease-associated enteropathy could decrease pathologists\u2019 endoscopic duodenal biopsy workload by up to 80%.<\/jats:p>","DOI":"10.3390\/diagnostics15121483","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T03:44:58Z","timestamp":1749613498000},"page":"1483","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Duodenal Biopsy Audit: Relative Frequency of Diagnoses, Key Words on Request Forms Indicating Severe Pathology, and Potential Diagnoses for Intraepithelial Lymphocytosis, as a Foundation for Developing Artificial Intelligence Diagnostic Approaches"],"prefix":"10.3390","volume":"15","author":[{"given":"Vrinda","family":"Shenoy","sequence":"first","affiliation":[{"name":"Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, Cambridgeshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7813-3776","authenticated-orcid":false,"given":"Jessica L.","family":"James","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, Cambridgeshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia B.","family":"Williams-Walker","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, Cambridgeshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasyen P. R.","family":"Madhan Mohan","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, Cambridgeshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5670-1832","authenticated-orcid":false,"given":"Kim N.","family":"Luu Hoang","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, Cambridgeshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Williams","sequence":"additional","affiliation":[{"name":"Human Research Tissue Bank, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, Cambridgeshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4607-6476","authenticated-orcid":false,"given":"Florian","family":"Jaeckle","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, Cambridgeshire, UK"},{"name":"Lyzeum Ltd., Salisbury House, Station Road, Cambridge CB1 2LA, Cambridgeshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3242-6017","authenticated-orcid":false,"given":"Shelley C.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, Cambridgeshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4032-7249","authenticated-orcid":false,"given":"Elizabeth J.","family":"Soilleux","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, Cambridgeshire, UK"},{"name":"Lyzeum Ltd., Salisbury House, Station Road, Cambridge CB1 2LA, Cambridgeshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1136\/jcp.55.5.393","article-title":"Quantitation of Intraepithelial Lymphocytes in Human Duodenum: What Is Normal?","volume":"55","author":"Hayat","year":"2002","journal-title":"J. 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