Concordancia entre la impresión diagnóstica de vasculitis con afectación cutánea realizado por especialistas y el diagnóstico de vasculitis por biopsia de piel en pacientes adultos en un hospital universitario en Colombia

Resumen

Background: cutaneous vasculitis represents a diagnostic challenge due to its varied clinical
presentations and potential overlap with other dermatological conditions. Biopsy confirmation
is often required for a definitive diagnosis; however, concordance between clinical suspicion
and histopathological findings remains uncertain.
Objective: to determine the concordance between the diagnostic impression made by
specialists and the histopathological diagnosis obtained from skin biopsies in adult patients.
Methods: this retrospective study analyzed 200 patients who underwent skin biopsy at a
tertiary care hospital in Colombia between February 2017 and December 2024. Patients were
categorized according to clinical suspicion of vasculitis by dermatologists or rheumatologists.
Clinical features and histopathological findings were collected and analyzed. Diagnostic
concordance was assessed using Cohen's kappa coefficient.
Results: 107 patients with clinical suspicions of vasculitis were included, 80 of them confirmed
by biopsy, additionally 19 patients of 93 who were included for another rheumatological clinical
suspicion confirmed vasculitis. The mean age of patients at the time of biopsy was 46.9 years,
with a female predominance (55.5%). Small vessel vasculitis was the predominant
pathological finding (n = 87, 87.8%), followed by medium-sized vessel vasculitis (n = 6,
6.06%), and finally, small-medium vessel vasculitis (n = 6, 6.06 %) cases., Concordance
analysis revealed moderate agreement between clinical suspicion and histopathological
confirmation for dermatologists (κ = 0.54; 95% CI: 0.43 to 0.67) and acceptable agreement for
rheumatologists (κ = 0.27; 95% CI: -0.3 to 0.85). No significant association was found between
specialist experience and diagnostic agreement in vasculitis (p = 0.083). No differences were
observed in inflammatory biomarkers among patients with or without confirmed vasculitis.
Conclusions: this study highlights the low diagnostic agreement between clinical and biopsyconfirmed vasculitis, emphasizing and highlighting the need for biopsy collection as a
diagnostic tool. Paraclinical tests do not appear to be decisive for performing skin biopsy.

Fecha de lectura	2025
Idioma original	Español
Institución de lectura	Pontificia Universidad Javeriana