Marietta Iacucci1,2, Rosanna Cannatelli1, Xianyong Gui3, Davide Zardo4, Alina Bazarova1, Georgios V Gkoutos1, Brendan Cord Lethebe5, Gilaad G Kaplan2, Remo Panaccione2, Ralf Kiesslich6, Subrata Ghosh1,2. 1. Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, UK. 2. Division of Gastroenterology and Hepatology, University of Calgary, Canada. 3. Department of Pathology, University of Washington, USA. 4. Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK. 5. Department of Community Health Sciences, Clinical Research Unit, University of Calgary, Canada. 6. Department of Medicine, HSK Hospital, Wiesbaden, Germany.
Abstract
BACKGROUND: Several studies have reported that ulcerative colitis [UC] patients with endoscopic mucosal healing may still have histological inflammation. We investigated the relationship between mucosal healing defined by modified PICaSSO [Paddington International Virtual ChromoendoScopy ScOre], Mayo Endoscopic Score [MES] and probe-based confocal laser endomicroscopy [pCLE] with histological indices in UC. METHODS: A prospective study enrolling 82 UC patients [male 66%] was conducted. High-definition colonoscopy was performed to evaluate the activity of the disease with MES assessed with High-Definition MES [HD-MES] and modified PICaSSO and targeted biopsies were taken; pCLE was then performed. Receiver operating characteristic [ROC] curves were plotted to determine the best thresholds for modified PICaSSO and pCLE scores that predicted histological healing according to the Robarts Histopathology Index [RHI] and ECAP 'Extension, Chronicity, Activity, Plus' histology score. RESULTS: A modified PICaSSO of ≤ 4 predicted histological healing at RHI ≤ 3, with sensitivity, specificity, accuracy and area under the ROC curve [AUROC] of 89.8%, 95.7%, 91.5% and 95.9% respectively. The sensitivity, specificity, accuracy and AUROC of HD-MES to predict histological healing by RHI were 81.4%, 95.7%, 85.4% and 92.1%, respectively. A pCLE ≤ 10 predicted histological healing with sensitivity of 94.9%, specificity of 91.3%, accuracy of 93.9% and AUROC of 96.5%. An ECAP of ≤ 10 was predicted by modified PICaSSO ≤ 4 with accuracy of 91.5% and AUROC of 95.9%. CONCLUSION: Histological healing by RHI and ECAP is accurately predicted by HD-MES and modified virtual electronic chromoendoscopy PICaSSO, endoscopic score; and the use of pCLE did not improve the accuracy any further.
BACKGROUND: Several studies have reported that ulcerative colitis [UC] patients with endoscopic mucosal healing may still have histological inflammation. We investigated the relationship between mucosal healing defined by modified PICaSSO [Paddington International Virtual ChromoendoScopy ScOre], Mayo Endoscopic Score [MES] and probe-based confocal laser endomicroscopy [pCLE] with histological indices in UC. METHODS: A prospective study enrolling 82 UCpatients [male 66%] was conducted. High-definition colonoscopy was performed to evaluate the activity of the disease with MES assessed with High-Definition MES [HD-MES] and modified PICaSSO and targeted biopsies were taken; pCLE was then performed. Receiver operating characteristic [ROC] curves were plotted to determine the best thresholds for modified PICaSSO and pCLE scores that predicted histological healing according to the Robarts Histopathology Index [RHI] and ECAP 'Extension, Chronicity, Activity, Plus' histology score. RESULTS: A modified PICaSSO of ≤ 4 predicted histological healing at RHI ≤ 3, with sensitivity, specificity, accuracy and area under the ROC curve [AUROC] of 89.8%, 95.7%, 91.5% and 95.9% respectively. The sensitivity, specificity, accuracy and AUROC of HD-MES to predict histological healing by RHI were 81.4%, 95.7%, 85.4% and 92.1%, respectively. A pCLE ≤ 10 predicted histological healing with sensitivity of 94.9%, specificity of 91.3%, accuracy of 93.9% and AUROC of 96.5%. An ECAP of ≤ 10 was predicted by modified PICaSSO ≤ 4 with accuracy of 91.5% and AUROC of 95.9%. CONCLUSION: Histological healing by RHI and ECAP is accurately predicted by HD-MES and modified virtual electronic chromoendoscopy PICaSSO, endoscopic score; and the use of pCLE did not improve the accuracy any further.
Authors: Olga Maria Nardone; Alina Bazarova; Pradeep Bhandari; Rosanna Cannatelli; Marco Daperno; Jose Ferraz; Martin Goetz; Xianyong Gui; Bu Hayee; Gert De Hertogh; Mark Lazarev; Ji Li; Adolfo Parra-Blanco; Luca Pastorelli; Remo Panaccione; Vincenzo Occhipinti; Timo Rath; Samuel C L Smith; Uday N Shivaji; Gian Eugenio Tontini; Michael Vieth; Vincenzo Villanacci; Davide Zardo; Raf Bisschops; Ralf Kiesslich; Subrata Ghosh; Marietta Iacucci Journal: United European Gastroenterol J Date: 2022-02-23 Impact factor: 4.623