A histopathologic scoring system as a tool for standardized reporting of chronic (ileo)colitis and independent risk assessment for inflammatory bowel disease.

Hum Pathol. 2012 Dec;43(12):2187-96.

Naini BV, Cortina G.

Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095-1732, USA. bnaini@mednet.ucla.edu

Abstract

Pathologists regularly evaluate for the presence of chronic (ileo)colitis in lower gastrointestinal mucosal biopsies, for which a major differential diagnosis is inflammatory bowel disease. Although the histologic features of chronic (ileo)colitis are clearly defined, there is no standard, experimentally derived and validated terminology to document these findings in pathology reports and to convey the likelihood of inflammatory bowel disease in a compact, consistent style. This study had 2 retrospective and 1 prospective phases. In phase 1, we developed a histopathologic scoring system for chronic (ileo)colitis and measured the agreement in scoring between pathologists. In phase 2, we emulated the surgical pathology practice by scoring mucosal biopsies of 164 patients who had undergone lower gastrointestinal endoscopies for clinical suspicion of (ileo)colitis. The cases were matched to 6 different groups based on clinical diagnoses. In phase 3, we prospectively assessed accuracy and ease of application of the scoring system in our practice. The scoring system showed low interobserver variability (correlation coefficient, 0.94-0.96) and distinguished chronic (ileo)colitis from negative cases. In addition, it enabled us to provide probabilistic diagnostic statements based on total scores and their positive predictive values, conveying the likelihood of inflammatory bowel disease as low (<20%), intermediate (∼50%), and high (∼90%). In conclusion, this histopathologic scoring system might be a useful approach to report the findings of lower gastrointestinal mucosal biopsies and to provide measured opinion regarding chronic (ileo)colitis independent of available clinical information. In addition, a defined set of diagnostic statements with regard to likelihood of inflammatory bowel disease would reduce interpretive variability.

PMID: 22703923

 

Supplement:

In this study, the authors present a histopathologic-based point system for evaluation of mucosal biopsies for chronic (ileo)-colitis. The goal is to provide an independent pathological confirmation of the clinical impression of (ileo)-colitis, rather than usurping the clinical impression or merely be “consistent with” it. It is well-known that there is no specific histopathologic finding for inflammatory bowel disease (IBD), but rather a heterogeneous constellation of findings that are characteristic of IBD. The authors present a validated scoring system (see Table below) that enables the pathologists to communicate a low, moderate, and high probability of IBD in a reproducible fashion.

Sample scoring and reporting worksheet for histologic assessment of chronic (ileo)-colitis, and probability of inflammatory bowel
disease (IBD):

 

SCORING

ILEITIS

Point value           Histologic finding

0,1,2                       architectural distortion

0,1,2                       increased lymphoplasmacytic inflammation in lamina propria

0,1,2                       increased neutrophils including erosion/ulcer

0,1,2                       granulomas

0,1,2                       pyloric metaplasia

TOTAL ILEITIS SCORE: -/10

 

COLITIS

Point value           Histologic finding

0,1,2                       crypt architectural distortion

0,1,2                       basal lymphoplasmacytosis

0,1,2                       cryptitis and crypt abscess

0,1,2                       increased lamina propria eosinophils

0,1,2                       erosions/ulcers

0,1,2                       granulomas

0,1,2                       Paneth cell/pyloric metaplasia

0,1                          lymphoid nodules at base

0,1                          muscularis mucosae hyperplasia/splaying/disruption

0,1                          endocrine cell hyperplasia

TOTAL COLITIS SCORE: -/17

 

REPORTING

Diagnostic statements independent of clinical information:

Chronic ileitis (score= x/10)

The likelihood* of IBD is low (x≤2)

The likelihood of IBD is moderate (x=3 to 4)

The likelihood of IBD is high (x≥5)

Chronic colitis (score= x/17)

The likelihood of IBD is low (x≤3)

The likelihood of IBD is moderate (x=4 to 8)

The likelihood of IBD is high (x≥9)

* Only the highest statement of probability needs to be used.

 

Diagnostic statements to complement clinical suspicion of IBD:

Chronic ileitis (score= x/10)

The histopathologic support** for IBD is low (x≤3)

The histopathologic support for IBD is moderate (x=3 to 4)

The histopathologic support for IBD is high (x≥5)

Chronic colitis (score= x/17)

The histopathologic support for IBD is low (x≤3)

The histopathologic support for IBD is moderate (x=4 to 8)

The histopathologic support for IBD is high (x≥9)

** Only the highest statement of probability needs to be used.

 

Contact:

Bita V. Naini, M.D.

Assistant Professor of Pathology

David Geffen School of Medicine at UCLA

10833 Le Conte Ave, 1P-172 CHS

Los Angeles, CA 90095-1732

T:  310-825-0863

bnaini@mednet.ucla.edu

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