Evaluating the optimum number of biopsies to assess histological inflammation in ulcerative colitis: a retrospective cohort study
Summary Background The optimal ulcerative colitis biopsy protocol is unclear. Aim To evaluate the number of biopsies required to accurately assess microscopic disease activity in ulcerative colitis Methods Biopsies from patients with ≥4 rectosigmoid samples, and clinical and endoscopic data, were re...
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| Veröffentlicht in: | Alimentary pharmacology & therapeutics 2020-11, Vol.52 (10), p.1574-1582 |
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| creator | Battat, Robert Vande Casteele, Niels Pai, Rish K. Wang, Zhongya Zou, Guangyong McDonald, John W. D. Duijvestein, Marjolijn Jeyarajah, Jenny Parker, Claire E. Van Viegen, Tanja Nelson, Sigrid A. Boland, Brigid S. Singh, Siddharth Dulai, Parambir S. Valasek, Mark A. Feagan, Brian G. Jairath, Vipul Sandborn, William J. |
| description | Summary
Background
The optimal ulcerative colitis biopsy protocol is unclear.
Aim
To evaluate the number of biopsies required to accurately assess microscopic disease activity in ulcerative colitis
Methods
Biopsies from patients with ≥4 rectosigmoid samples, and clinical and endoscopic data, were retrospectively obtained from a prospective biobank. Histology and endoscopic videos were read blindly. A 4‐biopsy Robarts Histopathology Index (RHI) reference score, consisting of the worst item‐level ratings from four biopsies, was compared to 1‐, 2‐ and 3‐biopsy estimates. Agreement was determined using bivariate errors‐in‐variable regression analysis (acceptance interval: ±8.25). Endoscopic activity and disease location subgroup analyses were also performed.
Results
Forty‐six patients had ≥4 rectosigmoid biopsies available (N = 287). The 2‐biopsy (tolerance interval: −7.66, 4.79) and 3‐biopsy (tolerance interval: −4.86, 3.46) RHI scores demonstrated acceptable agreement with 4‐biopsy scores. One‐biopsy scores demonstrated unacceptable agreement (tolerance interval: −13.99, 7.78). Mean RHI scores using the 2‐, 3‐ and 4‐biopsy approaches were similar (6.1 ± 9.6 P = 0.36; 6.8 ± 10.5, P = 0.7; 7.5 ± 11.2), whereas the 1‐biopsy estimate was lower (4.4 ± 8.1, P = 0.06). Histological remission rates were identical for the 2‐, 3‐ and 4‐biopsy methods (65.2%, P = 1.0). Subgroup analysis demonstrated that three biopsies were required in patients with endoscopically active disease. Sampling additional colonic locations yielded lower histological remission rates compared to rectosigmoid sampling alone (33.3% vs 61.9%, P = 0.1).
Conclusions
A minimum of two — conservatively, three — biopsies are required to reliably assess disease activity in a single colonic segment using the RHI. Further studies are needed of endoscopically active patients and sampling locations. These results have implications for biopsy strategies in clinical trials and practice. |
| doi_str_mv | 10.1111/apt.16083 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2446995339</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2452548328</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3883-8b069ccf2caaf9c5d2d78758c5e1dd1038582f43cc077378ee87d3ff08432df23</originalsourceid><addsrcrecordid>eNp1kU1LHEEQhpuQEFeTQ_5AaMhFD6P9MR813kSMBoTkYM5Db0-129IzPfaHskf_eTrZNYdA6lIU9fBQxUvIJ85OeakztaRT3jKQb8iKy7apBJPtW7Jiou0rAVwekMMYHxhjbcfEe3IgRQ-cAazIy9WTclklO9_TtEHql2SnPNE5T2sM1Bu6tn6JFiNNnqoYMUa6sTF55--tVo7a2Tg1TUXh5zLQ7DSGMj0h1d7ZZOM5VTRgCj4uqPeLjQ-JxpTH7QfyzigX8eO-H5GfX6_uLm-q2-_X3y4vbistAWQFa9b2WhuhlTK9bkYxdtA1oBvk48iZhAaEqaXWrOtkB4jQjdIYBrUUoxHyiBzvvEvwjxljGiYbNTqnZvQ5DqKu275vpOwL-uUf9MHnMJfrCtWIpgYpoFAnO0qXz2JAMyzBTipsB86G37kMJZfhTy6F_bw35vWE41_yNYgCnO2AZ-tw-3_TcPHjbqf8BS2-mbc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2452548328</pqid></control><display><type>article</type><title>Evaluating the optimum number of biopsies to assess histological inflammation in ulcerative colitis: a retrospective cohort study</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Wiley Free Content</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Battat, Robert ; Vande Casteele, Niels ; Pai, Rish K. ; Wang, Zhongya ; Zou, Guangyong ; McDonald, John W. D. ; Duijvestein, Marjolijn ; Jeyarajah, Jenny ; Parker, Claire E. ; Van Viegen, Tanja ; Nelson, Sigrid A. ; Boland, Brigid S. ; Singh, Siddharth ; Dulai, Parambir S. ; Valasek, Mark A. ; Feagan, Brian G. ; Jairath, Vipul ; Sandborn, William J.</creator><creatorcontrib>Battat, Robert ; Vande Casteele, Niels ; Pai, Rish K. ; Wang, Zhongya ; Zou, Guangyong ; McDonald, John W. D. ; Duijvestein, Marjolijn ; Jeyarajah, Jenny ; Parker, Claire E. ; Van Viegen, Tanja ; Nelson, Sigrid A. ; Boland, Brigid S. ; Singh, Siddharth ; Dulai, Parambir S. ; Valasek, Mark A. ; Feagan, Brian G. ; Jairath, Vipul ; Sandborn, William J.</creatorcontrib><description>Summary
Background
The optimal ulcerative colitis biopsy protocol is unclear.
Aim
To evaluate the number of biopsies required to accurately assess microscopic disease activity in ulcerative colitis
Methods
Biopsies from patients with ≥4 rectosigmoid samples, and clinical and endoscopic data, were retrospectively obtained from a prospective biobank. Histology and endoscopic videos were read blindly. A 4‐biopsy Robarts Histopathology Index (RHI) reference score, consisting of the worst item‐level ratings from four biopsies, was compared to 1‐, 2‐ and 3‐biopsy estimates. Agreement was determined using bivariate errors‐in‐variable regression analysis (acceptance interval: ±8.25). Endoscopic activity and disease location subgroup analyses were also performed.
Results
Forty‐six patients had ≥4 rectosigmoid biopsies available (N = 287). The 2‐biopsy (tolerance interval: −7.66, 4.79) and 3‐biopsy (tolerance interval: −4.86, 3.46) RHI scores demonstrated acceptable agreement with 4‐biopsy scores. One‐biopsy scores demonstrated unacceptable agreement (tolerance interval: −13.99, 7.78). Mean RHI scores using the 2‐, 3‐ and 4‐biopsy approaches were similar (6.1 ± 9.6 P = 0.36; 6.8 ± 10.5, P = 0.7; 7.5 ± 11.2), whereas the 1‐biopsy estimate was lower (4.4 ± 8.1, P = 0.06). Histological remission rates were identical for the 2‐, 3‐ and 4‐biopsy methods (65.2%, P = 1.0). Subgroup analysis demonstrated that three biopsies were required in patients with endoscopically active disease. Sampling additional colonic locations yielded lower histological remission rates compared to rectosigmoid sampling alone (33.3% vs 61.9%, P = 0.1).
Conclusions
A minimum of two — conservatively, three — biopsies are required to reliably assess disease activity in a single colonic segment using the RHI. Further studies are needed of endoscopically active patients and sampling locations. These results have implications for biopsy strategies in clinical trials and practice.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.16083</identifier><identifier>PMID: 32981088</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Biopsy ; Biopsy - methods ; Biopsy - standards ; Calibration ; Clinical trials ; Cohort analysis ; Cohort Studies ; Colitis, Ulcerative - diagnosis ; Colitis, Ulcerative - pathology ; Colon, Sigmoid - pathology ; Endoscopy ; Female ; Histological Techniques - methods ; Histological Techniques - standards ; Histological Techniques - statistics & numerical data ; Humans ; Inflammation - diagnosis ; Inflammation - pathology ; Inflammatory bowel disease ; Male ; Middle Aged ; Patient Participation ; Prospective Studies ; Rectum - pathology ; Remission ; Reoperation - methods ; Reoperation - standards ; Reoperation - statistics & numerical data ; Reproducibility of Results ; Retrospective Studies ; Sampling ; Ulcerative colitis</subject><ispartof>Alimentary pharmacology & therapeutics, 2020-11, Vol.52 (10), p.1574-1582</ispartof><rights>2020 John Wiley & Sons Ltd</rights><rights>2020 John Wiley & Sons Ltd.</rights><rights>Copyright © 2020 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3883-8b069ccf2caaf9c5d2d78758c5e1dd1038582f43cc077378ee87d3ff08432df23</citedby><cites>FETCH-LOGICAL-c3883-8b069ccf2caaf9c5d2d78758c5e1dd1038582f43cc077378ee87d3ff08432df23</cites><orcidid>0000-0002-2640-7269 ; 0000-0002-6914-3822 ; 0000-0001-8510-2281 ; 0000-0002-7421-9764 ; 0000-0002-2692-221X ; 0000-0002-8587-5441 ; 0000-0002-1092-0033 ; 0000-0002-9514-2321 ; 0000-0002-3314-7960</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapt.16083$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapt.16083$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,1432,27922,27923,45572,45573,46407,46831</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32981088$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Battat, Robert</creatorcontrib><creatorcontrib>Vande Casteele, Niels</creatorcontrib><creatorcontrib>Pai, Rish K.</creatorcontrib><creatorcontrib>Wang, Zhongya</creatorcontrib><creatorcontrib>Zou, Guangyong</creatorcontrib><creatorcontrib>McDonald, John W. D.</creatorcontrib><creatorcontrib>Duijvestein, Marjolijn</creatorcontrib><creatorcontrib>Jeyarajah, Jenny</creatorcontrib><creatorcontrib>Parker, Claire E.</creatorcontrib><creatorcontrib>Van Viegen, Tanja</creatorcontrib><creatorcontrib>Nelson, Sigrid A.</creatorcontrib><creatorcontrib>Boland, Brigid S.</creatorcontrib><creatorcontrib>Singh, Siddharth</creatorcontrib><creatorcontrib>Dulai, Parambir S.</creatorcontrib><creatorcontrib>Valasek, Mark A.</creatorcontrib><creatorcontrib>Feagan, Brian G.</creatorcontrib><creatorcontrib>Jairath, Vipul</creatorcontrib><creatorcontrib>Sandborn, William J.</creatorcontrib><title>Evaluating the optimum number of biopsies to assess histological inflammation in ulcerative colitis: a retrospective cohort study</title><title>Alimentary pharmacology & therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>Summary
Background
The optimal ulcerative colitis biopsy protocol is unclear.
Aim
To evaluate the number of biopsies required to accurately assess microscopic disease activity in ulcerative colitis
Methods
Biopsies from patients with ≥4 rectosigmoid samples, and clinical and endoscopic data, were retrospectively obtained from a prospective biobank. Histology and endoscopic videos were read blindly. A 4‐biopsy Robarts Histopathology Index (RHI) reference score, consisting of the worst item‐level ratings from four biopsies, was compared to 1‐, 2‐ and 3‐biopsy estimates. Agreement was determined using bivariate errors‐in‐variable regression analysis (acceptance interval: ±8.25). Endoscopic activity and disease location subgroup analyses were also performed.
Results
Forty‐six patients had ≥4 rectosigmoid biopsies available (N = 287). The 2‐biopsy (tolerance interval: −7.66, 4.79) and 3‐biopsy (tolerance interval: −4.86, 3.46) RHI scores demonstrated acceptable agreement with 4‐biopsy scores. One‐biopsy scores demonstrated unacceptable agreement (tolerance interval: −13.99, 7.78). Mean RHI scores using the 2‐, 3‐ and 4‐biopsy approaches were similar (6.1 ± 9.6 P = 0.36; 6.8 ± 10.5, P = 0.7; 7.5 ± 11.2), whereas the 1‐biopsy estimate was lower (4.4 ± 8.1, P = 0.06). Histological remission rates were identical for the 2‐, 3‐ and 4‐biopsy methods (65.2%, P = 1.0). Subgroup analysis demonstrated that three biopsies were required in patients with endoscopically active disease. Sampling additional colonic locations yielded lower histological remission rates compared to rectosigmoid sampling alone (33.3% vs 61.9%, P = 0.1).
Conclusions
A minimum of two — conservatively, three — biopsies are required to reliably assess disease activity in a single colonic segment using the RHI. Further studies are needed of endoscopically active patients and sampling locations. These results have implications for biopsy strategies in clinical trials and practice.</description><subject>Adult</subject><subject>Biopsy</subject><subject>Biopsy - methods</subject><subject>Biopsy - standards</subject><subject>Calibration</subject><subject>Clinical trials</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Colitis, Ulcerative - diagnosis</subject><subject>Colitis, Ulcerative - pathology</subject><subject>Colon, Sigmoid - pathology</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Histological Techniques - methods</subject><subject>Histological Techniques - standards</subject><subject>Histological Techniques - statistics & numerical data</subject><subject>Humans</subject><subject>Inflammation - diagnosis</subject><subject>Inflammation - pathology</subject><subject>Inflammatory bowel disease</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient Participation</subject><subject>Prospective Studies</subject><subject>Rectum - pathology</subject><subject>Remission</subject><subject>Reoperation - methods</subject><subject>Reoperation - standards</subject><subject>Reoperation - statistics & numerical data</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Sampling</subject><subject>Ulcerative colitis</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1LHEEQhpuQEFeTQ_5AaMhFD6P9MR813kSMBoTkYM5Db0-129IzPfaHskf_eTrZNYdA6lIU9fBQxUvIJ85OeakztaRT3jKQb8iKy7apBJPtW7Jiou0rAVwekMMYHxhjbcfEe3IgRQ-cAazIy9WTclklO9_TtEHql2SnPNE5T2sM1Bu6tn6JFiNNnqoYMUa6sTF55--tVo7a2Tg1TUXh5zLQ7DSGMj0h1d7ZZOM5VTRgCj4uqPeLjQ-JxpTH7QfyzigX8eO-H5GfX6_uLm-q2-_X3y4vbistAWQFa9b2WhuhlTK9bkYxdtA1oBvk48iZhAaEqaXWrOtkB4jQjdIYBrUUoxHyiBzvvEvwjxljGiYbNTqnZvQ5DqKu275vpOwL-uUf9MHnMJfrCtWIpgYpoFAnO0qXz2JAMyzBTipsB86G37kMJZfhTy6F_bw35vWE41_yNYgCnO2AZ-tw-3_TcPHjbqf8BS2-mbc</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Battat, Robert</creator><creator>Vande Casteele, Niels</creator><creator>Pai, Rish K.</creator><creator>Wang, Zhongya</creator><creator>Zou, Guangyong</creator><creator>McDonald, John W. D.</creator><creator>Duijvestein, Marjolijn</creator><creator>Jeyarajah, Jenny</creator><creator>Parker, Claire E.</creator><creator>Van Viegen, Tanja</creator><creator>Nelson, Sigrid A.</creator><creator>Boland, Brigid S.</creator><creator>Singh, Siddharth</creator><creator>Dulai, Parambir S.</creator><creator>Valasek, Mark A.</creator><creator>Feagan, Brian G.</creator><creator>Jairath, Vipul</creator><creator>Sandborn, William J.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>M7N</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2640-7269</orcidid><orcidid>https://orcid.org/0000-0002-6914-3822</orcidid><orcidid>https://orcid.org/0000-0001-8510-2281</orcidid><orcidid>https://orcid.org/0000-0002-7421-9764</orcidid><orcidid>https://orcid.org/0000-0002-2692-221X</orcidid><orcidid>https://orcid.org/0000-0002-8587-5441</orcidid><orcidid>https://orcid.org/0000-0002-1092-0033</orcidid><orcidid>https://orcid.org/0000-0002-9514-2321</orcidid><orcidid>https://orcid.org/0000-0002-3314-7960</orcidid></search><sort><creationdate>202011</creationdate><title>Evaluating the optimum number of biopsies to assess histological inflammation in ulcerative colitis: a retrospective cohort study</title><author>Battat, Robert ; Vande Casteele, Niels ; Pai, Rish K. ; Wang, Zhongya ; Zou, Guangyong ; McDonald, John W. D. ; Duijvestein, Marjolijn ; Jeyarajah, Jenny ; Parker, Claire E. ; Van Viegen, Tanja ; Nelson, Sigrid A. ; Boland, Brigid S. ; Singh, Siddharth ; Dulai, Parambir S. ; Valasek, Mark A. ; Feagan, Brian G. ; Jairath, Vipul ; Sandborn, William J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3883-8b069ccf2caaf9c5d2d78758c5e1dd1038582f43cc077378ee87d3ff08432df23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Biopsy</topic><topic>Biopsy - methods</topic><topic>Biopsy - standards</topic><topic>Calibration</topic><topic>Clinical trials</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Colitis, Ulcerative - diagnosis</topic><topic>Colitis, Ulcerative - pathology</topic><topic>Colon, Sigmoid - pathology</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Histological Techniques - methods</topic><topic>Histological Techniques - standards</topic><topic>Histological Techniques - statistics & numerical data</topic><topic>Humans</topic><topic>Inflammation - diagnosis</topic><topic>Inflammation - pathology</topic><topic>Inflammatory bowel disease</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient Participation</topic><topic>Prospective Studies</topic><topic>Rectum - pathology</topic><topic>Remission</topic><topic>Reoperation - methods</topic><topic>Reoperation - standards</topic><topic>Reoperation - statistics & numerical data</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Sampling</topic><topic>Ulcerative colitis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Battat, Robert</creatorcontrib><creatorcontrib>Vande Casteele, Niels</creatorcontrib><creatorcontrib>Pai, Rish K.</creatorcontrib><creatorcontrib>Wang, Zhongya</creatorcontrib><creatorcontrib>Zou, Guangyong</creatorcontrib><creatorcontrib>McDonald, John W. D.</creatorcontrib><creatorcontrib>Duijvestein, Marjolijn</creatorcontrib><creatorcontrib>Jeyarajah, Jenny</creatorcontrib><creatorcontrib>Parker, Claire E.</creatorcontrib><creatorcontrib>Van Viegen, Tanja</creatorcontrib><creatorcontrib>Nelson, Sigrid A.</creatorcontrib><creatorcontrib>Boland, Brigid S.</creatorcontrib><creatorcontrib>Singh, Siddharth</creatorcontrib><creatorcontrib>Dulai, Parambir S.</creatorcontrib><creatorcontrib>Valasek, Mark A.</creatorcontrib><creatorcontrib>Feagan, Brian G.</creatorcontrib><creatorcontrib>Jairath, Vipul</creatorcontrib><creatorcontrib>Sandborn, William J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Battat, Robert</au><au>Vande Casteele, Niels</au><au>Pai, Rish K.</au><au>Wang, Zhongya</au><au>Zou, Guangyong</au><au>McDonald, John W. D.</au><au>Duijvestein, Marjolijn</au><au>Jeyarajah, Jenny</au><au>Parker, Claire E.</au><au>Van Viegen, Tanja</au><au>Nelson, Sigrid A.</au><au>Boland, Brigid S.</au><au>Singh, Siddharth</au><au>Dulai, Parambir S.</au><au>Valasek, Mark A.</au><au>Feagan, Brian G.</au><au>Jairath, Vipul</au><au>Sandborn, William J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluating the optimum number of biopsies to assess histological inflammation in ulcerative colitis: a retrospective cohort study</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2020-11</date><risdate>2020</risdate><volume>52</volume><issue>10</issue><spage>1574</spage><epage>1582</epage><pages>1574-1582</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Summary
Background
The optimal ulcerative colitis biopsy protocol is unclear.
Aim
To evaluate the number of biopsies required to accurately assess microscopic disease activity in ulcerative colitis
Methods
Biopsies from patients with ≥4 rectosigmoid samples, and clinical and endoscopic data, were retrospectively obtained from a prospective biobank. Histology and endoscopic videos were read blindly. A 4‐biopsy Robarts Histopathology Index (RHI) reference score, consisting of the worst item‐level ratings from four biopsies, was compared to 1‐, 2‐ and 3‐biopsy estimates. Agreement was determined using bivariate errors‐in‐variable regression analysis (acceptance interval: ±8.25). Endoscopic activity and disease location subgroup analyses were also performed.
Results
Forty‐six patients had ≥4 rectosigmoid biopsies available (N = 287). The 2‐biopsy (tolerance interval: −7.66, 4.79) and 3‐biopsy (tolerance interval: −4.86, 3.46) RHI scores demonstrated acceptable agreement with 4‐biopsy scores. One‐biopsy scores demonstrated unacceptable agreement (tolerance interval: −13.99, 7.78). Mean RHI scores using the 2‐, 3‐ and 4‐biopsy approaches were similar (6.1 ± 9.6 P = 0.36; 6.8 ± 10.5, P = 0.7; 7.5 ± 11.2), whereas the 1‐biopsy estimate was lower (4.4 ± 8.1, P = 0.06). Histological remission rates were identical for the 2‐, 3‐ and 4‐biopsy methods (65.2%, P = 1.0). Subgroup analysis demonstrated that three biopsies were required in patients with endoscopically active disease. Sampling additional colonic locations yielded lower histological remission rates compared to rectosigmoid sampling alone (33.3% vs 61.9%, P = 0.1).
Conclusions
A minimum of two — conservatively, three — biopsies are required to reliably assess disease activity in a single colonic segment using the RHI. Further studies are needed of endoscopically active patients and sampling locations. These results have implications for biopsy strategies in clinical trials and practice.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32981088</pmid><doi>10.1111/apt.16083</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-2640-7269</orcidid><orcidid>https://orcid.org/0000-0002-6914-3822</orcidid><orcidid>https://orcid.org/0000-0001-8510-2281</orcidid><orcidid>https://orcid.org/0000-0002-7421-9764</orcidid><orcidid>https://orcid.org/0000-0002-2692-221X</orcidid><orcidid>https://orcid.org/0000-0002-8587-5441</orcidid><orcidid>https://orcid.org/0000-0002-1092-0033</orcidid><orcidid>https://orcid.org/0000-0002-9514-2321</orcidid><orcidid>https://orcid.org/0000-0002-3314-7960</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0269-2813 |
| ispartof | Alimentary pharmacology & therapeutics, 2020-11, Vol.52 (10), p.1574-1582 |
| issn | 0269-2813 1365-2036 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2446995339 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Wiley Free Content; EZB-FREE-00999 freely available EZB journals |
| subjects | Adult Biopsy Biopsy - methods Biopsy - standards Calibration Clinical trials Cohort analysis Cohort Studies Colitis, Ulcerative - diagnosis Colitis, Ulcerative - pathology Colon, Sigmoid - pathology Endoscopy Female Histological Techniques - methods Histological Techniques - standards Histological Techniques - statistics & numerical data Humans Inflammation - diagnosis Inflammation - pathology Inflammatory bowel disease Male Middle Aged Patient Participation Prospective Studies Rectum - pathology Remission Reoperation - methods Reoperation - standards Reoperation - statistics & numerical data Reproducibility of Results Retrospective Studies Sampling Ulcerative colitis |
| title | Evaluating the optimum number of biopsies to assess histological inflammation in ulcerative colitis: a retrospective cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-09T20%3A49%3A12IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Evaluating%20the%20optimum%20number%20of%20biopsies%20to%20assess%20histological%20inflammation%20in%20ulcerative%20colitis:%20a%20retrospective%20cohort%20study&rft.jtitle=Alimentary%20pharmacology%20&%20therapeutics&rft.au=Battat,%20Robert&rft.date=2020-11&rft.volume=52&rft.issue=10&rft.spage=1574&rft.epage=1582&rft.pages=1574-1582&rft.issn=0269-2813&rft.eissn=1365-2036&rft_id=info:doi/10.1111/apt.16083&rft_dat=%3Cproquest_cross%3E2452548328%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2452548328&rft_id=info:pmid/32981088&rfr_iscdi=true |