Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2023; 29(2): 378-389
Published online Jan 14, 2023. doi: 10.3748/wjg.v29.i2.378
Knowledge and attitudes towards the use of histological assessments in ulcerative colitis by gastroenterologists vs pathologists
Aviv Pudipeddi, Caroline Fung, Britt Christensen, Robert V Bryant, Kavitha Subramaniam, John Chetwood, Sudarshan Paramsothy, Rupert W Leong
Aviv Pudipeddi, John Chetwood, Sudarshan Paramsothy, Rupert W Leong, Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney 2139, Australia
Aviv Pudipeddi, Sudarshan Paramsothy, Rupert W Leong, Faculty of Medicine and Health, Concord Clinical School, University of Sydney, Sydney 2138, Australia
Caroline Fung, Department of Anatomical Pathology, Concord Repatriation General Hospital, Sydney 2139, Australia
Britt Christensen, Department of Gastroenterology, Royal Melbourne Hospital, Melbourne 3050, Australia
Britt Christensen, Department of Medicine, University of Melbourne, Melbourne 3052, Australia
Robert V Bryant, Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Adelaide 5011, Australia
Kavitha Subramaniam, Gastroenterology and Hepatology Unit, Canberra Hospital, Canberra 2605, Australia
Kavitha Subramaniam, Australian National University Medical School, Australian National University, Canberra 2601, Australia
Sudarshan Paramsothy, Rupert W Leong, Faculty of Medicine and Health Sciences, Macquarie University Hospital, Sydney 2109, Australia
Author contributions: Pudipeddi A and Leong RW designed the research study. Pudipeddi A, Chetwood J, Paramsothy S and Leong RW performed the research and collected data. Pudipeddi A, Chetwood J and Leong RW analysed the data. Pudipeddi A drafted the manuscript. Fung C, Christensen B, Bryant RV and Subramaniam K edited the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: The study was approved by the Sydney Local Health District Human Research Ethics Committee (HREC CH62/6/2021-055).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest.
Data sharing statement: The data underlying this article will be shared on reasonable request to the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Aviv Pudipeddi, FRACP, MBBS, Doctor, Gastroenterology and Liver Services, Concord Repatriation General Hospital, Level 1West ACE Unit, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney 2139, Australia. avivpudipeddi@gmail.com
Received: September 11, 2022
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
Processing time: 116 Days and 12.6 Hours
Abstract
BACKGROUND

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.

AIM

To evaluate the knowledge of histology guidelines and attitudes towards the use of histology in UC by gastroenterologists and pathologists.

METHODS

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.

RESULTS

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).

CONCLUSION

Histological remission is a recognised target for both gastroenterologists and pathologists. Despite this, knowledge of histological scoring systems and their utilisation is poor.

Keywords: Histology; Scoring system; Ulcerative colitis; Survey

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.