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P212. How to ameliorate histology accuracy in IBD diagnosis: role for a better interaction between clinicians and pathologists?

M. Daperno1,2, G. Canavese3, R. Suriani1, A. Sapino3, R. Rocca1,2, V. Villanacci4, O. Onlus1, on behalf of Fondazione IBD, 1Fondazione IBD Onlus, IBD Foundation, Torino, Italy, 2AO Ordine Mauriziano, Gastroenterology Division, Turin, Italy, 3AO S. Giovanni Battista - Città della Salute, Pathology Department, Torino, Italy, 4Spedali Civili di Brescia, Pathology Depratment, Brescia, Italy

Background

Guidelines state that diagnosis of Inflammatory Bowel Disease (IBD) is the result of multidisciplinary collaboration between clinician and pathologist. An effective diagnostic approach is crucial in order to avoid inappropriate treatments and ineffective clinical management in patients investigated for known or suspected IBD.

Aim of this study was to evaluate the adherence to the current ECCO diagnostic guidelines of a set of clinical, endoscopic, and histopathological parameters in routine diagnosis of IBD in Piedmont.

Methods

As a part of a study promoted by Fondazione IBD Onlus, consecutive histopathological and endoscopic reports related to 311 patients were collected from 11 centres in Piedmont. Clinical an endoscopic data, the sites of the endoscopic sampling, the histopathological variables and the diagnostic conclusions present in each single report were abstracted and analysed comparing to the European Crohn's and Colitis Organization (ECCO) requirements [1,2].

Results

The percentages of cases that satisfied the standards of quality are summarised in the Table.

The only data reported quite frequently regarded whether the examination occurred in a suspected/known IBD case (84%). In 90% of cases standard bioptic sampling (ileum plus sampling of each colonic segment, with a minimum of 2 biopsies/site) was not accomplished.

In more than half of the cases the result of pathology examination was inconclusive (e.g. without a definite IBD diagnosis, either Crohn, ulcerative colitis or IBD-unclassified), and standard histhology landmarks of IBD were not reported explicitely in half-to-two thirds of the examinations.

Table: Relevant characteristics of endoscopy/clinical and histopathology records; raw percentages of 311 records analysed are reported.
CharacteristicObserved
Characteristics of information sent to pathologists
Indication of timing (first diagnosis/follow-up)84%
Symptoms description24%
Active treatments description15%
Indication of time from symptoms onset12%
Laboratory results (biochemistry)<5%
Bioptic sampling characteristics
Standard sampling fulfilled (at least 2 biopsies from ileum + each segment)10%
Biopsies oriented on acetate strips0%
Characteristics of histopatology report
Final diagnosis of IBD explicitly stated47%
Cryptitis/crypt abscess described56%
Crypt architectural distortion described38%
Ulcers described31%
Basal plasmocytosis described3%

Conclusion

These preliminary results outline that standards of quality prescribed by ECCO guidelines are rarely met in clinical practice. Nonetheless, a conclusive diagnostic classification is achieved in slightly less than half of the records examined. Basal plasmocytosis, which appear to be a relevant IBD landmark, was seldom reported in this series.

These results suggest that there is place for educational interventions aimed at ameliorating clinicians-pathologists interplay and to increase the quality of endoscopic sampling and of histopathological reports.