A reproducible grading scale for histological assessment of inflammation in ulcerative colitis
A reproducible grading scale for histological assessment of inflammation in ulcerative colitis
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DOI：
10.1136/gut.47.3.404
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发表时间：
2000-09-01
期刊：
影响因子：
24.5
通讯作者：
Löfberg, R
中科院分区：
文献类型：
--
作者：
Geboes, K;Riddell, R;Löfberg, R
背景-溃疡性结肠炎的组织学活性评估需要重复性，但很少被测试。这在临床和临床试验中都是有用的。目的：制定可重复性的标准，用于评估急性炎症(活动性)和慢性，并在观察者间变异性研究中评估这些特征。方法-建立一个六级炎症分类系统，该分类系统也可以在每个级别内进行微调。分级：0，单纯结构改变；1，慢性炎症；2，中性粒细胞固有层；3，上皮中性粒细胞；4，腺体破坏；5，糜烂或溃疡。来自远端溃疡性结肠炎患者的99个内窥镜下炎症和非炎症粘膜的苏木精-伊红切片由三个病理学家独立地在不知道临床状态的情况下在两个单独的读数中进行评估。观察者间的一致性使用kappa统计进行两两比较。结果-最初，观察者之间的kappa值分别为0.20、0.42和0.26，这些值太低而没有价值。在为每个标准制定了一个半定量的图像量表之后，卡伯值分别提高到0.62、0.70和0.59。以上皮细胞之间的中性粒细胞定义的活性，卡伯值分别为0.903、1.000和0.907。在镜下正常的组织样本和66%的镜下炎症组织样本中完全一致。上皮中性粒细胞与隐窝破坏和溃疡的存在相关。结论：建立的溃疡性结肠炎组织学活动系统具有良好的重复性，并与内窥镜分级系统进行了补充。它在临床和临床试验中都具有潜在的价值。
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.