Histologic Features of Colon Biopsies (Geboes Score) Associated With Progression of Ulcerative Colitis for the First 36 Months After Biopsy

Magro, Fernando; Alves, Catarina; Lopes, Joanne; Lopes, Susana; Sousa, Helena Tavares de; Cotter, José; Silva, Vitor Macedo da; Lago, Paula; Vieira, Ana Isabel; Brito, Mariana; Duarte, Maria Antónia; Portela, Francisco; Silva, Joao; Ministro, Paula; Arroja, Bruno; Carvalho, Liliana; Torres, Joana; Santiago, Mafalda; Estevinho, María Manuela; Danese, Silvio; Peyrin–Biroulet, Laurent; Dias, Cláudia Camila; Borralho, Paula; Feakins, Roger; Carneiro, Fátima

doi:10.1016/j.cgh.2020.09.017

Cited by 18 publications

(13 citation statements)

References 26 publications

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“…Admittedly, our work has a few limitations. First, our patients’ follow-up protocol did not include the endoscopic and histological reassessments at 12 months (not standard of care in all centres), and second it only lasted 12 months, whereas some clinical outcomes might be observed even after 36 months 49. Third, we did not follow-up patients using patient-reported outcomes similar to other studies1 15 as symptoms do not relate well to histology or endoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…First, our patients’ follow-up protocol did not include the endoscopic and histological reassessments at 12 months (not standard of care in all centres), and second it only lasted 12 months, whereas some clinical outcomes might be observed even after 36 months. 49 Third, we did not follow-up patients using patient-reported outcomes similar to other studies 1 15 as symptoms do not relate well to histology or endoscopy. Fourth, we have not yet tested sufficiently the global score of PHRI throughout different regions of the entire colon in patients with pan-colitis, although we did include two sites (rectum and sigmoid) in the present study which recruited a diverse cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

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PICaSSO Histologic Remission Index (PHRI) in ulcerative colitis: development of a novel simplified histological score for monitoring mucosal healing and predicting clinical outcomes and its applicability in an artificial intelligence system

Gui

Bazarova

Amor

et al. 2022

Gut

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Histological remission is evolving as an important treatment target in UC. We aimed to develop a simple histological index, aligned to endoscopy, correlated with clinical outcomes, and suited to apply to an artificial intelligence (AI) system to evaluate inflammatory activity.MethodsUsing a set of 614 biopsies from 307 patients with UC enrolled into a prospective multicentre study, we developed the Paddington International virtual ChromoendoScopy ScOre (PICaSSO) Histologic Remission Index (PHRI). Agreement with multiple other histological indices and validation for inter-reader reproducibility were assessed. Finally, to implement PHRI into a computer-aided diagnosis system, we trained and tested a novel deep learning strategy based on a CNN architecture to detect neutrophils, calculate PHRI and identify active from quiescent UC using a subset of 138 biopsies.ResultsPHRI is strongly correlated with endoscopic scores (Mayo Endoscopic Score and UC Endoscopic Index of Severity and PICaSSO) and with clinical outcomes (hospitalisation, colectomy and initiation or changes in medical therapy due to UC flare-up). A PHRI score of 1 could accurately stratify patients’ risk of adverse outcomes (hospitalisation, colectomy and treatment optimisation due to flare-up) within 12 months. Our inter-reader agreement was high (intraclass correlation 0.84). Our preliminary AI algorithm differentiated active from quiescent UC with 78% sensitivity, 91.7% specificity and 86% accuracy.ConclusionsPHRI is a simple histological index in UC, and it exhibits the highest correlation with endoscopic activity and clinical outcomes. A PHRI-based AI system was accurate in predicting histological remission.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

PICaSSO Histologic Remission Index (PHRI) in ulcerative colitis: development of a novel simplified histological score for monitoring mucosal healing and predicting clinical outcomes and its applicability in an artificial intelligence system

Gui

Bazarova

Amor

et al. 2022

Gut

Self Cite

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“…Magro et al, in a larger sample of 399 asymptomatic patients, showed that higher grades of histological activity as measured by GS are associated with incremental risks of UC progression over 36 months (a composite endpoint of surgery, pharmacologic escalation, corticosteroid use, hospitalization): patients with GS > 2B.0, GS > 3.0 or GS > 4.0 were more likely to show UC progression, more quickly, than patients with GS ≤ 2B.0, GS ≤ 3.0 or GS ≤ 4.0 (p < 0.001). Disease progression also occurred earlier in patients with GS > 2B.0, GS > 3.0 or GS > 4.0 compared with patients with GS ≤ 2B.0 (HR, 2.021; 95% CI, 1.158-3.526), GS ≤ 3.0 (HR, 2.007; 95% CI, 1.139-3.534) or GS ≤ 4.0 (HR, 2.349; 95% CI, 1.269-4.349) [43]. D'Amico et al demonstrated similar results using NI: of the 186 patents included, a significantly higher percentage of patients with baseline activity (NI ≥ 1) underwent colectomies over the course of 1 year as compared with those in remission (14.0% vs. 0.0%, p = 0.01).…”

Section: Histologic Healing In Ibd: Towards Disease Clearance?mentioning

confidence: 99%

Histological Scores in Patients with Inflammatory Bowel Diseases: The State of the Art

D’Amico

Sollai

Allocca

et al. 2022

JCM

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The histological assessment has been advocated as a detailed and accurate measure of disease activity in inflammatory bowel diseases (IBD). In ulcerative colitis (UC), histological activity has been demonstrated to be associated with higher rates of relapse, prolonged corticosteroid use and long-term complications, even when endoscopic remission is achieved. Therefore, histological healing may represent a potential treatment target. Several histological scores have been developed and are available today. The Robarts histopathology index (RHI) and the Nancy index (NI) are the only two recommended by the European Crohn’s and Colitis Organization (ECCO) for use in patients with UC. Conversely, in Crohn’s disease (CD), the discontinuous nature of lesions has limited standardized histological assessment. Most of the available histological scoring systems in CD are complex and not validated. The aim of this review is to comprehensively summarize the latest evidence regarding histological scoring systems in IBD. We guide the reader through understanding the importance of an accurate microscopic evaluation using validated scoring systems, highlighting the strengths and pitfalls of each score. The priorities of future research needs are also addressed.

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“…Of these scores, the 'Geboes score' developed in 2000 has been the most widely used and can serve as an independent risk factor for disease progression in UC [24,25]. The more recent 'Nancy histological index' (NHI) and 'Robarts histopathological index' (RHI) both from 2016 have proven feasible, easy to use, and are the most extensively validated [26,27].…”

Section: Measuring the Disease Activity In Ulcerative Colitismentioning

confidence: 99%

The Role of the Pathologist in Ulcerative Colitis

Mahendra¹,

Hewavisenthi²

2022

Ulcerative Colitis - Etiology, Diagnosis, Diet, Special Populations, and the Role of Interventional Endoscopy

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Pathologists have an essential and wide role in the management of patients with ulcerative colitis (UC) which is a chronic inflammatory disorder of the bowel with remissions and relapses. The initial diagnosis of UC itself is challenging as the histological features vary widely with the clinical phase of the disease. Differentiating UC from other types of acute and chronic colitis, especially Crohn’s disease is crucial in the management. Understanding the characteristic morphological features of UC as well as unusual morphological features of the disease are important in this task. The histological disease activity has now been identified as important in therapeutic decisions. There are several histological activity indices in UC and currently, the Nancy histological index has been recommended to be used in daily clinical practice. Identifying dysplasia associated with UC and its grading is a challenging task for the pathologist and it is a crucial step in the surveillance and management of this chronic disease.

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Histologic Features of Colon Biopsies (Geboes Score) Associated With Progression of Ulcerative Colitis for the First 36 Months After Biopsy

Cited by 18 publications

References 26 publications

PICaSSO Histologic Remission Index (PHRI) in ulcerative colitis: development of a novel simplified histological score for monitoring mucosal healing and predicting clinical outcomes and its applicability in an artificial intelligence system

PICaSSO Histologic Remission Index (PHRI) in ulcerative colitis: development of a novel simplified histological score for monitoring mucosal healing and predicting clinical outcomes and its applicability in an artificial intelligence system

Histological Scores in Patients with Inflammatory Bowel Diseases: The State of the Art

The Role of the Pathologist in Ulcerative Colitis

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