Histopathological assessment of the microscopic activity in inflammatory bowel diseases: What are we looking for?

Table 1 Original Geboes score

Original Geboes score
Grade 0: Architectural changes	0.0 No abnormality; 0.1 Mild abnormality; 0.2 Mild/moderate diffuse or multifocal abnormalities; 0.3 Severe diffuse or multifocal abnormalities
Grade 1: Chronic inflammatory infiltrate	1.0 No increase; 1.1 Mild but unequivocal increase; 1.2 Moderate increase; 1.3 Marked increase
Grade 2A: Eosinophils in lamina propria	2A.0 No increase; 2A.1 Mild but unequivocal increase; 2A.2 Moderate increase; 2A.3 Marked increase
Grade 2B: Neutrophils in lamina propria	2B.0 No increase; 2B.1 Mild but unequivocal increase; 2B.2 Moderate increase; 2B.3 Marked increase
Grade 3: Neutrophils in epithelium	3.0 None; 3.1 < 5% crypts involved; 3.2 < 50% crypts involved; 3.3 > 50% crypts involved
Grade 4: Crypt destruction	4.0 None; 4.1 Probable: local excess of neutrophils in part of the crypts; 4.2 Probable: marked attenuation; 4.3 Unequivocal crypt destruction
Grade 5: Erosions and ulcerations	5.0 No erosion, ulceration or granulation tissue; 5.1 Recovering epithelium + adjacent inflammation; 5.2 Probable erosion: focally stripped; 5.3 Unequivocal erosion; 5.4 Ulcer or granulation tissue

Table 2 Simplified Geboes score

Simplified Geboes score
Grade 0: No inflammatory activity	0.0 No abnormalities; 0.1 Presence of architectural changes; 0.2 Presence of architectural changes and chronic mononuclear cell infiltrate
Grade 1: Basal plasma cells	1.0 No increase; 1.1 Mild increase; 1.2 Marked increase
Grade 2A: Eosinophils in lamina propria	2A.0 No increase; 2A.1 Mild increase; 2A.2 Marked increase
Grade 2B: Neutrophils in lamina propria	2B.0 No increase; 2B.1 Mild increase; 2B.2 Marked increase
Grade 3: Neutrophils in epithelium	3.0 None; 3.1 < 50% crypts involved; 3.2 > 50% crypts involved
Grade 4: Epithelial injury (in crypt and surface epithelium)	4.0 None; 4.1 Marked attenuation; 4.2 Probable crypt destruction: probable erosions; 4.3 Unequivocal crypt destruction: unequivocal erosion; 4.4 Ulcer or granulation tissue

Table 3 Robarts histopathology index

Histopathological variable	Grade
Chronic inflammatory infiltrate	0 = No increase; 1 = Mild but unequivocal increase; 2 = Moderate increase; 3 = Marked increase
Lamina propria neutrophils	0 = None; 1 = Mild but unequivocal increase; 2 = Moderate increase; 3 = Marked increase
Neutrophils in epithelium	0 = None; 1 = 50% crypts involved
Erosion or ulceration	0 = No erosion, ulceration or granulation tissue; 1 = Recovering epithelium + adjacent inflammation; 2 = Probable erosion-focally stripped; 3 = Unequivocal erosion; 4 = Ulcer or granulation tissue

Table 4 Nancy histological index

Grade	Criteria
Grade 0 (no histological significant disease)	No or mild increase in chronic inflammatory infiltrate
Grade 1 (chronic inflammatory infiltrate with no acute inflammatory infiltrate)	Moderate or marked increase in chronic inflammatory infiltrate that is easily apparent. No acute inflammatory infiltrate is present
Grade 2 (mildly active disease)	Few or rare neutrophils in lamina propria or in the epithelium that are difficult to see
Grade 3 (moderately active disease)	Presence of multiple clusters of neutrophils in lamina propria and/or in epithelium that are easily apparent
Grade 4 (severely active disease)	Loss of colonic crypts replaced with “immature” granulation tissue (disorganized blood vessels with extravasated neutrophils) or the presence of fibrinopurulent exudate

Table 5 Global Histology Activity Score

Histopathological variable	Grade
Epithelial damage	0 = Normal; 1 = Focal; 2 = Extensive
Architectural changes	0 = Normal; 1 = Moderate; 2 = Severe
Mononuclear cells in lamina propria	0 = Normal; 1 = Moderate increase; 2 = Severe increase
Neutrophils in lamina propria	0 = Normal; 1 = Moderate increase; 2 = Severe increase
Neutrophils in epithelium	1 = Surface epithelium; 2 = Cryptitis; 3 = Crypt abscess
Erosion or ulceration	0 = No; 1 = Yes
Granuloma	0 = No; 1 = Yes
Number of segmental biopsy specimens affected	1 = < 1/3; 2 = 1/3-2/3; 3 = > 2/3

Each variable is scored independently. The total score is the sum of all individual scores.

Table 6 Inflammatory Bowel Disease-Distribution, Chronicity, Activity score

Histopathological variable	Grade
Distribution	0 = Normal; 1 = < 50% of tissue affected per same biopsy site; 2 = > 50% of tissue affected per same biopsy
Chronicity	0 = Normal; 1 = Crypt distortion and/or mild lymphoplasmacytosis; 2 = Marked lymphoplasmacytosis and/or basal plasmacytosis
Activity	0 = Normal; 1 = Two or more neutrophils in lamina propria in one high-power field and/or any presence of intraepithelial neutrophils; 2 = Crypt abscesses, erosions, ulcers

Each variable is scored independently.