Measuring Histologic Activity in Inflammatory Bowel Disease: Why and How

Abstract

Histology is used to confirm the diagnosis of inflammatory bowel disease, exclude superimposed infections, and to evaluate for dysplasia. Histology has rarely been used to measure disease activity and guide therapy despite evidence that histologic measurements have value in predicting important clinical outcomes. More recently, there have been numerous studies supporting a role for histologic disease activity measurements in predicting a variety of outcomes including relapse, hospitalizations, steroid use, and dysplasia. The histologic assessment was superior to endoscopic measurements in many of these studies. This review will summarize the recent literature regarding histologic disease activity measurements in ulcerative colitis and Crohn disease. A detailed description of histologic scoring systems will also be provided to provide pathologists with the necessary tools to accurately measure disease activity.

Artificial Intelligence Enables Quantitative Assessment of Ulcerative Colitis Histology

“…We compared our RFC predictions to the majority consensus scores of a selected group of subspeciality trained pathologists with near perfect ICC. Since histological scoring is likely to be incorporated into routine diagnostic practice [29], future ‘real world’ studies are needed to determine relative performance of the model amongst a greater number of pathologists of broader background and experience. Ongoing work will allow prediction of additional histological scoring systems, and explore associations with clinical metadata.…”

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

“…It is a highly specific feature for the diagnosis of IBD, especially at early stages. However, it has relatively low sensitivity, as it can be focal and can be missed by a biopsy [15,16]. Of note, basal plasmacytosis may predict disease relapse in IBD.…”

“…Surface epithelial damage is unanimously considered the most severe sign of acute inflammation, and if present, usually the highest grade of activity of any scoring system is given [15,16]. Mucosal breaks are defined as the loss of normal epithelium, which is replaced with granulation tissue or by clearly evident fibrinous exudate.…”

“…Most of them never underwent required validation, and such plurality may have contributed to confusion among pathologists, clinicians and researchers. To reliably assess microscopic activity and ensure easy adoption, an accurate, easy-to-use and reproducible score should be available, ideally [15]. Initially developed indexes are likely to be far from that definition, and only over the last few years have substantial efforts been made to standardize histological assessments of IBD, through consensus generation which promoted development and implementation of meticulously validated scoring systems [16].…”

Histopathological assessment of the microscopic activity in inflammatory bowel diseases: What are we looking for?

“…Erosions were traditionally defined as defects confined to the mucosa, whilst ulcerations penetrated deeper into the submucosa, but there is no strict adherence to this criterion in pathological practice. Currently, ulcerations are often recognized rather by the presence of granulation tissue and erosions by fibrinopurulent exudate covering the defect[ 4 , 19 , 20 ]. The inflammatory infiltrate is often accompanied by numerous eosinophils.…”