Bokemeyer Arne, Buskermolen Joost, Ketelhut Steffi, Tepasse Phil-Robin, Vollenberg Richard, Trebicka Jonel, Schmidt Hartmut H, Vieth Michael, Bettenworth Dominik, Kemper Björn
Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital of Essen, University Duisburg-Essen, 45147 Essen, Germany.
Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Muenster, 48149 Muenster, Germany.
J Clin Med. 2023 Jun 15;12(12):4067. doi: 10.3390/jcm12124067.
Ulcerative colitis (UC) is characterized by chronic inflammation of the colorectum. Histological remission has emerged as a potential future treatment goal; however, the histopathological assessment of intestinal inflammation in UC remains challenging with a multitude of available scoring systems and the need for a pathologist with expertise in inflammatory bowel disease (IBD). In previous studies, quantitative phase imaging (QPI) including digital holographic microscopy (DHM) was successfully applied as an objective method for stain-free quantification of the degree of inflammation in tissue sections. Here, we evaluated the application of DHM for the quantitative assessment of histopathological inflammation in patients with UC. In our study, endoscopically obtained colonic and rectal mucosal biopsy samples from 21 patients with UC were analyzed by capturing DHM-based QPI images that were subsequently evaluated using the subepithelial refractive index (RI). The retrieved RI data were correlated with established histological scoring systems including the Nancy index (NI) as well as with endoscopic and clinical findings. As a primary endpoint, we found a significant correlation between the DHM-based retrieved RI and the NI (R = 0.251, < 0.001). Furthermore, RI values correlated with the Mayo endoscopic subscore (MES; R = 0.176, < 0.001). An area under the receiver operating characteristics (ROC) curve of 0.820 confirms the subepithelial RI as a reliable parameter to distinguish biopsies with histologically active UC from biopsies without evidence of active disease as determined by conventional histopathological examination. An RI higher than 1.3488 was found to be the most sensitive and specific cut-off value to identify histologically active UC (sensitivity of 84% and specificity of 72%). In conclusion, our data demonstrate DHM to be a reliable tool for the quantitative assessment of mucosal inflammation in patients with UC.
溃疡性结肠炎(UC)的特征是结肠直肠的慢性炎症。组织学缓解已成为未来潜在的治疗目标;然而,由于有多种可用的评分系统,且需要一名在炎症性肠病(IBD)方面有专业知识的病理学家,UC肠道炎症的组织病理学评估仍然具有挑战性。在先前的研究中,包括数字全息显微镜(DHM)在内的定量相位成像(QPI)已成功应用于对组织切片中炎症程度进行无染色定量的客观方法。在此,我们评估了DHM在UC患者组织病理学炎症定量评估中的应用。在我们的研究中,通过捕获基于DHM的QPI图像,对21例UC患者经内镜获取的结肠和直肠黏膜活检样本进行了分析,随后使用上皮下折射率(RI)对这些图像进行评估。检索到的RI数据与包括南希指数(NI)在内的既定组织学评分系统以及内镜和临床发现相关。作为主要终点,我们发现基于DHM检索到的RI与NI之间存在显著相关性(R = 0.251,< 0.001)。此外,RI值与梅奥内镜亚评分(MES;R = 0.176,< 0.001)相关。受试者工作特征(ROC)曲线下面积为0.820,证实上皮下RI是区分组织学上有活动期UC的活检样本与经传统组织病理学检查无活动疾病证据的活检样本的可靠参数。发现RI高于1.3488是识别组织学上有活动期UC的最敏感和特异的临界值(敏感性为84%,特异性为72%)。总之,我们的数据表明DHM是UC患者黏膜炎症定量评估的可靠工具。