Published online Jan 14, 2023. doi: 10.3748/wjg.v29.i2.378
Peer-review started: September 11, 2022
First decision: October 22, 2022
Revised: November 4, 2022
Accepted: December 23, 2022
Article in press: December 23, 2022
Published online: January 14, 2023
Histological remission is increasingly accepted as a treatment endpoint in the management of ulcerative colitis (UC). However, the knowledge of histology guidelines and the attitudes towards their use in clinical practice by gastroenterologists and pathologists is unknown.
To evaluate the knowledge of histology guidelines and attitudes towards the use of histology in UC by gastroenterologists and pathologists.
A prospective, cross-sectional nationwide survey of gastroenterologists and pathologists who analyse UC specimens was conducted. The survey consisted of 34 questions to assess gastroenterologists’ and pathologists’ knowledge (score out of 19) and attitudes towards histological assessment in UC. Survey questions were formulated using the European Crohn’s and Colitis position paper on histopathology and the British Society of Gastroenterology biopsy reporting guidelines. It included knowledge of histological assessment of disease activity and dysplasia, knowledge of histological scoring systems for ulcerative colitis, uptake of histology scoring systems in routine practice, attitudes towards the role of histological activity, and the use of histological activity in clinical scenarios.
Of 89 responders (77 gastroenterologists, 12 pathologists), there was almost universal acceptance that histological assessment should form part of UC evaluation [95% gastroenterologists, 92% pathologists]. However, gastroenterologists reported that 92% of their pathologists do not use a histological scoring system. Utilisation of a formal histological scoring system was preferred by 77% of gastroenterologists and 58% of pathologists. Both groups lacked awareness of the Geboes Score, Nancy Index and Robarts Histopathological Index scoring systems with 91%, 87%, and 92% of gastroenterologists respectively; and 83%, 83%, and 92% pathologists respectively, being uncertain of scoring systems’ remission definitions. Histology knowledge score was not significantly different between gastroenterologists and pathologists [9/19 (IQR: 8-11) vs 8/19 (IQR: 7-10), P = 0.54]. Higher knowledge scores were predicted by hospital attending gastroenterologists (P = 0.004), participation in inflammatory bowel disease (IBD) multidisciplinary teams (P = 0.009), and self-declared IBD sub-specialist (P = 0.03).
Histological remission is a recognised target for both gastroenterologists and pathologists. Despite this, knowledge of histological scoring systems and their utilisation is poor.
Core Tip: This manuscript describes, for the first time, the knowledge and attitudes of gastroenterologists and pathologists towards the use of histology in clinical practice. Given the increasing literature and use of histology in trials, there is a need to understand the current perceptions of using histology in the real-world. Using a novel Inflammatory Bowel Disease Knowledge score, we demonstrate that although histology is an accepted endpoint, knowledge is poor, particularly relating to histological scoring systems. As such, these results illustrate a pressing need and opportunity to improve knowledge around histology scores amongst gastroenterologists and pathologists and develop consensus agreements on a reporting approach.