An International Consensus to Standardize Integration of Histopathology in Ulcerative Colitis Clinical Trials.
An International Consensus to Standardize Integration of Histopathology in Ulcerative Colitis Clinical Trials.
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DOI：
10.1053/j.gastro.2021.02.035
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发表时间：
2021-06
期刊：
影响因子：
29.4
通讯作者：
Jairath V
中科院分区：
文献类型：
--
作者：
Ma C;Sedano R;Almradi A;Vande Casteele N;Parker CE;Guizzetti L;Schaeffer DF;Riddell RH;Pai RK;Battat R;Sands BE;Rosty C;Dubinsky MC;Rieder F;Harpaz N;Abreu MT;Bryant RV;Lauwers GY;Kirsch R;Valasek MA;Crowley E;Sandborn WJ;Feagan BG;Pai RK;Jairath V
Histopathology is an emerging treatment target in ulcerative colitis (UC) clinical trials. We aim to provide guidance on standardizing biopsy collection protocols, identifying optimal evaluative indices, and defining thresholds for histologic response and remission after treatment. An international, interdisciplinary expert panel of 19 gastroenterologists and gastrointestinal pathologists was assembled. A modified RAND/University of California Los Angeles appropriateness methodology was used to address relevant issues. A total of 138 statements were derived from a systematic review of the literature and expert opinion. Each statement was anonymously rated as appropriate, uncertain, or inappropriate using a 9-point scale. Survey results were reviewed and discussed prior to a second round of voting. Histologic measurements collected using a uniform biopsy strategy are important for assessing disease activity and determining therapeutic efficacy in UC clinical trials. Multiple biopsy strategies were deemed acceptable, including segmental biopsies collected according to the endoscopic appearance. Biopsies should be scored for architectural change, lamina propria chronic inflammation, basal plasmacytosis, lamina propria and epithelial neutrophils, epithelial damage, and erosions/ulcerations. The Geboes Score, Robarts Histopathology Index, and Nancy Index were considered appropriate for assessing histologic activity; use of the modified Riley Score and Harpaz Index were uncertain. Histological activity at baseline should be required for enrollment, recognizing this carries operational implications. Achievement of histologic improvement or remission were considered appropriate and realistic therapeutic targets. Current histological indices require validation for pediatric populations. These recommendations provide a framework for standardized implementation of histopathology in UC trials. Additional work is required to address operational considerations and areas of uncertainty. We convened an interdisciplinary expert panel to create a standardized framework for collecting biopsies, interpreting histologic disease activity, and defining histologic response and remission for UC clinical trials.
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影响因子：
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作者：
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通讯作者：
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影响因子：
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