Maximizing the diagnostic information from biopsies in chronic inflammatory bowel diseases: recommendations from the Erlangen International Consensus Conference on Inflammatory Bowel Diseases and presentation of the IBD-DCA score as a proposal for a new index for histologic activity assessment in ulcerative colitis and Crohn’s disease

Lang-Schwarz, Corinna; Agaimy, Abbas; Atreya, Raja; Becker, Christoph; Danese, Silvio; Fléjou, Jean‐François; Gaßler, Nikolaus; Grabsch, Heike; Hartmann, Arndt; Kamarádová, Kateřina; Kühl, Anja A.; Lauwers, Gregory Y.; Lugli, Alessandro; Nagtegaal, Irıs D.; Neurath, Markus F.; Oberhuber, Georg; Peyrin–Biroulet, Laurent; Räth, Timo; Riddell, Robert H.; Rubio, Carlos A.; Sheahan, Kieran; Tilg, Herbert; Villanacci, Vincenzo; Westerhoff, Maria; Vieth, Michael

doi:10.1007/s00428-020-02982-7

Cited by 29 publications

(27 citation statements)

References 112 publications

(207 reference statements)

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“…A detailed description regarding how it was developed has already been published. 32 In brief, the score consists of three main parameters which also constitute the name of the new index and the order in which the score should be assessed:…”

Section: Methodsmentioning

confidence: 99%

“…Detailed recommendations regarding optimal biopsy sampling [including number of biopsies and sites] in order to maximise diagnostic information have also been published by our group. 32 Figure 1 shows histological examples for each possible parameter. Figure 2 shows an example for assessment of the IBD-DCA score.…”

Section: Methodsmentioning

confidence: 99%

“…The Inflammatory Bowel Disease—Distribution, Chronicity, Activity [IBD-DCA] score was initially developed during the International Consensus Conference on Inflammatory Bowel Disease, held in Erlangen, Germany, January 8‐10, 2020, with participants from 12 countries. 32 The aim of this study was to validate the new score.…”

Section: Introductionmentioning

confidence: 99%

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Validation of the ‘Inflammatory Bowel Disease—Distribution, Chronicity, Activity [IBD-DCA] Score’ for Ulcerative Colitis and Crohn´s Disease

Lang-Schwarz

Angeloni

Agaimy

et al. 2021

Journal of Crohn's and Colitis

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Background and aims Histological scoring plays a key role in the assessment of disease activity in ulcerative colitis (UC) and is also important in Crohn´s disease (CD). Currently, there is no common scoring available for UC and CD. We aimed to validate the Inflammatory Bowel Disease (IBD) – Distribution (D), Chronicity (C), Activity (A) score (IBD-DCA score) for histological disease activity assessment in IBD. Methods Inter- and intra-rater reliability were assessed by 16 observers on biopsy specimen from 59 patients with UC and 25 patients with CD. Construct validity and responsiveness to treatment were retrospectively evaluated on a second cohort of 30 patients. Results Inter-rater reliability was moderate to good for the UC cohort (intraclass correlation coefficients (ICCs) = 0.645, 0.623, 0.767 for D, C and A, respectively) and at best moderate for the CD cohort (ICC = 0.690, 0.303, 0.733 for D, C and A, respectively). Intra-rater agreement ranged from good to excellent in both cohorts. Correlation with the Nancy Histological Index (NHI) was moderate and strong with the Simplified Geboes Score (SGS) and a Visual Analog Scale (VAS). Large effect sizes (ES) were obtained for all three parameters. External responsiveness analysis revealed correlated changes between IBD-DCA score and NHI, SGS and VAS. Conclusions The IBD-DCA score is a simple histological activity score for UC and CD, agreed and validated by a large group of IBD specialists. It provides reliable information on treatment response. Therefore, it has potential value for use in routine diagnostics as well as clinical studies.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Validation of the ‘Inflammatory Bowel Disease—Distribution, Chronicity, Activity [IBD-DCA] Score’ for Ulcerative Colitis and Crohn´s Disease

Lang-Schwarz

Angeloni

Agaimy

et al. 2021

Journal of Crohn's and Colitis

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“…For a reliable diagnosis of IBD, at least two endoscopic biopsies each should be taken from at least five sites along the ileum, colon, and rectum [7][8][9][10][11]. The histological features of UC include non-active inflammation, active inflammation, structural changes, and epithelial abnormalities [5,8].…”

Section: Histological Characteristics Of Ucmentioning

confidence: 99%

“…Recently a new consensus-based scoring index has been proposed, intended for both clinical practice and clinical trials that still needs to be validated [10]. Although these are not applied routinely, the pathology report should include some information on the level of activity in the biopsies to assess the effect of therapy and the risk of relapse.…”

Section: Histologic Disease Activitymentioning

confidence: 99%

Histomorphological Diagnosis of Ulcerative Colitis and Associated Conditions

Jeruc¹

2022

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

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Ulcerative colitis (UC) is a chronic, idiopathic inflammatory disease that affects mainly young adults. The histologic examination of endoscopic biopsies or resection specimens plays an important part in the diagnosis and follow up of patients with inflammatory bowel disease, including UC. In this chapter, we discuss on main histological features that can be used when analyzing endoscopic biopsies, as well as features that can be evaluated in surgical samples of patients with UC. The differential diagnosis toward Crohn’s disease and other mimickers is emphasized. In addition, the main complications associated with treatment and long-standing diseases, such as infection colitis and dysplasia are presented.

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Deep learning‐based image analysis reveals significant differences in the number and distribution of mucosal CD3 and γδ T cells between Crohn's disease and ulcerative colitis

Røyset

Pettersen

et al. 2022

The Journal of Pathology CR

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Colon mucosae of ulcerative colitis (UC) and Crohn's disease (CD) display differences in the number and distribution of immune cells that are difficult to assess by eye. Deep learning‐based analysis on whole slide images (WSIs) allows extraction of complex quantitative data that can be used to uncover different inflammatory patterns. We aimed to explore the distribution of CD3 and γδ T cells in colon mucosal compartments in histologically inactive and active inflammatory bowel disease. By deep learning‐based segmentation and cell detection on WSIs from a well‐defined cohort of CD (n = 37), UC (n = 58), and healthy controls (HCs, n = 33), we quantified CD3 and γδ T cells within and beneath the epithelium and in lamina propria in proximal and distal colon mucosa, defined by the Nancy histological index. We found that inactive CD had significantly fewer intraepithelial γδ T cells than inactive UC, but higher total number of CD3 cells in all compartments than UC and HCs. Disease activity was associated with a massive loss of intraepithelial γδ T cells in UC, but not in CD. The total intraepithelial number of CD3 cells remained constant regardless of disease activity in both CD and UC. There were more mucosal CD3 and γδ T cells in proximal versus distal colon. Oral corticosteroids had an impact on γδ T cell numbers, while age, gender, and disease duration did not. Relative abundance of γδ T cells in mucosa and blood did not correlate. This study reveals significant differences in the total number of CD3 and γδ T cells in particularly the epithelial area between CD, UC, and HCs, and demonstrates useful application of deep segmentation to quantify cells in mucosal compartments.

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Cited by 29 publications

References 112 publications

Validation of the ‘Inflammatory Bowel Disease—Distribution, Chronicity, Activity [IBD-DCA] Score’ for Ulcerative Colitis and Crohn´s Disease

Validation of the ‘Inflammatory Bowel Disease—Distribution, Chronicity, Activity [IBD-DCA] Score’ for Ulcerative Colitis and Crohn´s Disease

Histomorphological Diagnosis of Ulcerative Colitis and Associated Conditions

Deep learning‐based image analysis reveals significant differences in the number and distribution of mucosal CD3 and γδ T cells between Crohn's disease and ulcerative colitis

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