02286nas a2200229   4500000000100000008004100001260004100042653002000083653002200103100001300125700001100138700001500149700001100164700001300175700001200188700001200200245010100212856022000313300001400533490000800547520150100555       2015                            d  bHind Kusht Nivaran Sangh aNew Delhi10aType 1 reaction10aReversal reaction1 aSharma I1 aKaur M1 aMishra A K1 aSood N1 aRamesh V1 aKubba A1 aSingh A00aHistopathological Diagnosis of Leprosy Type 1 Reaction with Emphasis on Interobserver Variation.  uhttp://www.researchgate.net/profile/Neelam_Sood/publication/283146862_Histopathological_Diagnosis_of_Leprosy_Type_1_Reaction_with_Emphasis_on_Interobserver_Variation_1_2_3_4_5_6_7/links/562c788a08ae22b170337961.pdf   a101 - 1070 v87 3 a<p>Editor's introduction:</p>

<p>Upgrading type1 lepra reaction or reversal reaction (RR) is an acute inflammatory complication of leprosy and a disparity exists between&nbsp;clinicians and pathologists for diagnosing a RR. Inter-observe<strong>r </strong>variations among pathologists also compound this problem as no universally agreed diagnostic criteria exist. 120 biopsies and H&amp;E stained slides were assessed by 3 pathologists. The pathologists were blinded to the clinical diagnosis and to each other's observations. Each pathologist assigned a likelihood of reaction by their histopathological observations as definitely reaction, probable reaction and no reaction. Clinicopathological correlation and interobserver agreement was analyzed statistically. Discordance between clinical and histopathological diagnosis was seen in 30.8% by pathologist 1(P1), 23.7% by pathologist 2 (P2) and 34.5% by the pathologist 3 (P3). Dermal edema, intragranuloma edema and epidermal erosion were consistent findings by all observers.</p>

<p>Definite reaction was seen in 54.2% of cases by P1, 53.3% by P2 and 34.5% by P3. Kappa statistics for strength of agreement showed good agreement between 3 pathologists with P1 (ê=0.83), P2 (ê= 0.61), P3 (ê=0.62). RR are underdiagnosed on histopathological examination but this study shows that dermal edema, edema within the granuloma and partial obliteration of grenz zone by granuloma are reliable clues to diagnose a RR on histopathology.</p>