Histological scoring systems in ulcerative colitis patients: a routine practice perspective

Abstract

Introduction. Histological healing has become a therapeutic goal in patients with ulcerative colitis. However, a consensus on its precise definition has not been reached yet. A large number of complex histological scoring systems for ulcerative colitis are available in literature making standardization a complicated issue. The objective of the study was to identify a histological scoring system that is adequate for routine practice and thus contributes to standardization of histological reporting of inflammation activity in ulcerative colitis. Materials and methods. We retrospectively reviewed and scored 64 H&E stained slides using Nancy index (NI), Geboes score (GS) and Robarts Histopathology Index (RHI). The level of inter-rater and intra-rater agreement, time needed for scoring per slide, and correlation between the histological scores and Mayo endoscopic score were further analysed statistically. Results. The inter-rater agreement was very good for NI (kappa=0.861) and GS (kappa=0.820), and moderate for RHI (kappa=0.592), p<0.005. The intra-rater agreement was very good for NI (kappa=0.973), GS (kappa=0.942), and RHI (kappa=0.892), p<0.005. NI needed the least time to rate (average of 72.06s/slide), followed by GS (77.55s/slide) and RHI (92.67s/slide). The differences were statistically significant by Friedman’s test. All scoring systems correlated well with Mayo score. Conclusions. Nancy index and Geboes score appeared as most suitable for assessment of inflammation in ulcerative colitis in routine practice. NI is fast and has a simple approach. Geboes score is more complex Though simple scores are more likely to be accepted in routine practice, complex scoring systems could be more appropriate for evaluation of histological healing and for research purposes.

Keywords

• ulcerative colitis
• nancy index
• geboes score
• robarts histopathology index
• histological scoring systems