Key result
Integrating molecular pathology with histopathology can improve endomyocardial biopsy accuracy for diagnosing rejection.
Why the study?
Recent molecular and digital pathology advances prompted the Banff Conference to address improving EMB diagnostic accuracy for rejection and resolving dilemmas surrounding the Quilty effect.
The XVth Banff Conference report highlights the need to integrate molecular technologies with traditional histopathology to improve the diagnostic accuracy of cardiac allograft rejection.
Answers are grounded in this paper and cite their sources.
May support molecular integration in cardiac allograft biopsy reads; leaves open prospective validation before practice change.
The XVth Banff Conference on Allograft Pathology meeting was held on September 23-27, 2019, in Pittsburgh, Pennsylvania, USA. During this meeting, two main topics in cardiac transplant pathology were addressed: (a) Improvement of endomyocardial biopsy (EMB) accuracy for the diagnosis of rejection and other significant injury patterns, and (b) the orphaned lesion known as Quilty effect or nodular endocardial infiltrates. Molecular technologies have evolved in recent years, deciphering pathophysiology of cardiac rejection. Diagnostically, it is time to integrate the histopathology of EMBs and molecular data. The goal is to incorporate molecular pathology, performed on the same paraffin block as a companion test for histopathology, to yield more accurate and objective EMB interpretation. Application of digital image analysis from hematoxylin and eosin (H&E) stain to multiplex labeling is another means of extracting additional information from EMBs. New concepts have emerged exploring the multifaceted significance of myocardial injury, minimal rejection patterns supported by molecular profiles, and lesions of arteriolitis/vasculitis in the setting of T cell-mediated rejection (TCMR) and antibody-mediated rejection (AMR). The orphaned lesion known as Quilty effect or nodular endocardial infiltrates. A state-of-the-art session with historical aspects and current dilemmas was reviewed, and possible pathogenesis proposed, based on advances in immunology to explain conflicting data. The Quilty effect will be the subject of a multicenter project to explore whether it functions as a tertiary lymphoid organ.
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Huyen et al. (2020) conducted a review in Cardiac transplant pathology. The XVth Banff Conference highlighted the integration of molecular pathology with histopathology to improve endomyocardial biopsy accuracy and proposed exploring the Quilty effect's pathogenesis.
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