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Mosli MH, Feagan BG, Zou G, Sandborn WJ, D'Haens G, Khanna R, Shackelton LM, Walker CW, Nelson S, Vandervoort MK, Frisbie V, Samaan MA, Jairath V, Driman DK, Geboes K, Valasek MA, Pai RK, Lauwers GY, Riddell R, Stitt LW, Levesque BG. Development and validation of a histological index for UC. Gut 2017; 66:50-58. [PMID: 26475633 DOI: 10.1136/gutjnl-2015-310393] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/15/2015] [Accepted: 09/22/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Although the Geboes score (GS) and modified Riley score (MRS) are commonly used to evaluate histological disease activity in UC, their operating properties are unknown. Accordingly, we developed an alternative instrument. DESIGN Four pathologists scored 48 UC colon biopsies using the GS, MRS and a visual analogue scale global rating. Intra-rater and inter-rater reliability for each index and individual index items were measured using intraclass correlation coefficients (ICCs). Items with high reliability were used to develop the Robarts histopathology index (RHI). The responsiveness/validity of the RHI and multiple histological, endoscopic and clinical outcome measures were evaluated by analyses of change scores, standardised effect size (SES) and Guyatt's responsiveness statistic (GRS) using data from a clinical trial of an effective therapy. RESULTS Inter-rater ICCs (95% CIs) for the total GS and MRS scores were 0.79 (0.63 to 0.87) and 0.80 (0.69 to 0.87). The correlation estimates between change scores in RHI and change score in GS and MRS were 0.75 (0.67 to 0.82) and 0.84 (0.79 to 0.88), respectively. The SES and GRS estimates for GS, MRS and RHI were: 1.87 (1.54 to 2.20) and 1.23 (0.97 to 1.50), 1.29 (1.02 to 1.56) and 0.88 (0.65 to 1.12), and 1.05 (0.79 to 1.30) and 0.88 (0.64 to 1.12), respectively. CONCLUSIONS The RHI is a new histopathological index with favourable operating properties.
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Affiliation(s)
- Mahmoud H Mosli
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Department of Medicine, University of Western Ontario, London, Ontario, Canada.,Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Brian G Feagan
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Department of Medicine, University of Western Ontario, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Guangyong Zou
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - William J Sandborn
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Geert D'Haens
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - Reena Khanna
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Lisa M Shackelton
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Christopher W Walker
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Sigrid Nelson
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Margaret K Vandervoort
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Valerie Frisbie
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Mark A Samaan
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Vipul Jairath
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - David K Driman
- Department of Pathology, University of Western Ontario, London, Ontario, Canada
| | - Karel Geboes
- Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium
| | - Mark A Valasek
- Department of Pathology, University of California, San Diego, USA
| | - Rish K Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, USA
| | - Gregory Y Lauwers
- Massachusetss General Hospital, Boston, USA.,Department of Pathology, Harvard Medical School, Boston, USA
| | - Robert Riddell
- Department of Pathology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Larry W Stitt
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Barrett G Levesque
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
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