A reproducible grading scale for histological assessment of inflammation in ulcerative colitis
K Geboes, R Riddell, A Ost, B Jensfelt, T Persson, R Löfberg, K Geboes, R Riddell, A Ost, B Jensfelt, T Persson, R Löfberg
Abstract
Background: Evaluation of histological activity in ulcerative colitis needs to be reproducible but has rarely been tested. This could be useful both clinically and in clinical trials.
Aim: To develop reproducible criteria which are valid in the assessment of acute inflammation (activity) and chronicity, and to evaluate these features in an interobserver variability study.
Methods: A six grade classification system for inflammation was developed which could also be fine tuned within each grade. The grades were: 0, structural change only; 1, chronic inflammation; 2, lamina propria neutrophils; 3, neutrophils in epithelium; 4, crypt destruction; and 5, erosions or ulcers. Ninety nine haematoxylin-eosin sections from endoscopically inflamed and non-inflamed mucosa from patients with distal ulcerative colitis were assessed in two separate readings by three pathologists independently and without knowledge of the clinical status. Interobserver agreement was compared pairwise using kappa statistics.
Results: Initially, kappa values between the observers were 0.20, 0.42, and 0.26, which are too low to be of value. Following development of a semiquantitative pictorial scale for each criterion, kappa values improved to 0.62, 0.70, and 0.59. For activity defined by neutrophils between epithelial cells, kappa values were 0.903, 1.000, and 0.907. Complete agreement was reached in 64% of samples of endoscopically normal and in 66% of endoscopically inflamed tissue. Neutrophils in epithelium correlated with the presence of crypt destruction and ulceration.
Conclusion: A histological activity system was developed for ulcerative colitis that showed good reproducibility and modest agreement with the endoscopic grading system which it complemented. It has potential value both clinically and in clinical trials.
Figures
References
- Am J Dig Dis. 1966 Nov;11(11):831-46
- Am J Dig Dis. 1966 Nov;11(11):847-57
- Dig Dis Sci. 1982 Jun;27(6):533-7
- Scand J Gastroenterol. 1982 Nov;17(8):1077-81
- Hum Pathol. 1984 Aug;15(8):757-63
- Scand J Gastroenterol. 1984 Jun;19(4):525-30
- Gastroenterology. 1987 Feb;92(2):318-28
- Scand J Gastroenterol. 1987 May;22(4):459-62
- Scand J Gastroenterol. 1987 Oct;22(8):987-92
- J Clin Pathol. 1988 Jan;41(1):72-9
- Gut. 1988 May;29(5):669-74
- Gut. 1991 Feb;32(2):174-8
- Gut. 1991 Dec;32(12):1514-20
- Am J Surg Pathol. 1993 Sep;17(9):869-75
- Scand J Gastroenterol. 1994 Apr;29(4):318-32
- Gut. 1994 Jul;35(7):961-8
- Hum Pathol. 1994 Nov;25(11):1150-9
- Gut. 1995 Feb;36(2):243-50
- Gut. 1995 Aug;37(2):242-6
- Gastrointest Endosc. 1995 Sep;42(3):232-7
- J Pathol. 1996 Jan;178(1):95-9
- Am J Gastroenterol. 1997 Feb;92(2):283-8
- J Clin Pathol. 1997 Feb;50(2):93-105
- Am J Surg Pathol. 1998 Aug;22(8):983-9
- Scand J Gastroenterol. 1999 Jan;34(1):55-67
- Am J Surg Pathol. 1999 Apr;23(4):423-30
Source: PubMed