Knowledge and attitudes towards the use of histological assessments in ulcerative colitis by gastroenterologists vs pathologists

Abstract

BACKGROUND Histological remission is increasingly accepted as a treatment endpoint in the management of ulcerative colitis (UC). However, the knowledge of histology guidelines and the attitudes towards their use in clinical practice by gastroenterologists and pathologists is unknown. AIM To evaluate the knowledge of histology guidelines and attitudes towards the use of histology in UC by gastroenterologists and pathologists. METHODS A prospective, cross-sectional nationwide survey of gastroenterologists and pathologists who analyse UC specimens was conducted. The survey consisted of 34 questions to assess gastroenterologists’ and pathologists’ knowledge (score out of 19) and attitudes towards histological assessment in UC. Survey questions were formulated using the European Crohn’s and Colitis position paper on histopathology and the British Society of Gastroenterology biopsy reporting guidelines. It included knowledge of histological assessment of disease activity and dysplasia, knowledge of histological scoring systems for ulcerative colitis, uptake of histology scoring systems in routine practice, attitudes towards the role of histological activity, and the use of histological activity in clinical scenarios. RESULTS Of 89 responders (77 gastroenterologists, 12 pathologists), there was almost universal acceptance that histological assessment should form part of UC evaluation [95% gastroenterologists, 92% pathologists]. However, gastroenterologists reported that 92% of their pathologists do not use a histological scoring system. Utilisation of a formal histological scoring system was preferred by 77% of gastroenterologists and 58% of pathologists. Both groups lacked awareness of the Geboes Score, Nancy Index and Robarts Histopathological Index scoring systems with 91%, 87%, and 92% of gastroenterologists respectively; and 83%, 83%, and 92% pathologists respectively, being uncertain of scoring systems’ remission definitions. Histology knowledge score was not significantly different between gastroenterologists and pathologists [9/19 (IQR: 8-11) vs 8/19 (IQR: 7-10), P = 0.54]. Higher knowledge scores were predicted by hospital attending gastroenterologists ( P = 0.004), participation in inflammatory bowel disease (IBD) multidisciplinary teams ( P = 0.009), and self-declared IBD sub-specialist ( P = 0.03). CONCLUSION Histological remission is a recognised target for both gastroenterologists and pathologists. Despite this, knowledge of histological scoring systems and their utilisation is poor.

Reporting of endoscopy and histology of ulcerative colitis in routine clinical practice: How far we are!

“…These features seem to indicate that the unbiased real‐world application of the scores, particularly histological ones, is lower. Indeed, another recent survey from Australia 11 reached slightly different conclusions when compared with the survey discussed here. Indeed, in this cohort of 89 gastroenterologists (from which, 30% self‐reported as subspecialists in IBD), <8% reported the use of a systematic histologic scoring system and <12% were certain of the proposed remission cut‐offs.…”

Quantitative Phase Imaging Using Digital Holographic Microscopy to Assess the Degree of Intestinal Inflammation in Patients with Ulcerative Colitis

“…Although histological assessment with the establishment of validated scoring systems, as described above, has made progress during the last years [ 3 ], many histological scoring systems do not consider all relevant aspects of IBD pathology, for example, basal plasmacytosis [ 16 , 17 , 23 ] and histological assessment as well as the fact that correct the usage of scoring systems requires highly experienced IBD pathologists [ 16 , 47 ]. Furthermore, it was recently shown that knowledge of IBD histological scoring systems and their utilization is poor amongst gastroenterologists and pathologists, despite recognition of their importance [ 48 ]. Therefore, quantitative, reliable, time-efficient, and automatable tools in terms of digital pathology are desired, which might be capable of assessing histological inflammation independently, as an additional support to the classic histological assessment that is performed by a pathologist.…”

Considering Histologic Remission in Ulcerative Colitis as a Long-Term Target

“…With this consideration in mind, we should accept the real-world struggles of proper histopathology score knowledge and proper reporting. In a recent survey from Australia, only around 10% of pathologists reported the use of a systematic histologic scoring system, and more than 80% lacked awareness regarding the definition of remission according to different scoring systems [ 18 ].…”