Abstract
BackgroundA validated histopathological tool to precisely evaluate bowel fibrosis in patients with Crohn’s disease is lacking. We attempted to establish a new index to quantify the severity of bowel fibrosis in patients with Crohn’s disease-associated fibrostenosis.MethodsWe analyzed the histopathological data of 31 patients with Crohn’s disease strictures undergoing surgical resection. The most representative sections of resected strictured segments were stained with Masson trichrome to manifest bowel fibrosis. The collagen area fraction and histological fibrosis score were simultaneously calculated for the same section to evaluate the severity of bowel fibrosis.ResultsCollagen area fraction strongly correlated with histological fibrosis scores (r = 0.733, P < 0.001). It showed a stronger correlation (r = 0.561, P < 0.001) with the degree of bowel strictures than the histological fibrosis score did (r = 0.468, P < 0.001). It was also shown to be more accurate for diagnosing Crohn’s disease strictures (area under the receiver operating characteristic curve = 0.815, P < 0.001) compared with the histological fibrosis score (area under the curve = 0.771, P < 0.001). High repeatability was observed for the collagen area fraction, with an intraclass correlation coefficient of 0.915 (P < 0.001).ConclusionsCollagen area fraction is a simple and reliable index to quantify the severity of bowel fibrosis in patients with Crohn’s disease-associated fibrostenosis.
Highlights
A validated histopathological tool to precisely evaluate bowel fibrosis in patients with Crohn’s disease is lacking
The purpose of this study was to develop and verify a simple and reliable histopathological index to quantify bowel fibrosis in patients with Crohn’s disease (CD) using a novel imaging segmentation technology. We compared this index with a published semiquantitatively histopathological grading scheme [10]. Patients This prospective study was approved by the ethical review board of our institution, and written informed consent was obtained from all CD patients who were treated with surgical resection
The most important findings in our study were that the collagen area fraction, which was calculated as the ratio between the area of the collagen fiber and the total area of the bowel wall, showed a good correlation with the histological fibrosis score in detecting bowel fibrosis and a higher accuracy for diagnosing CD strictures than the histological fibrosis score
Summary
A validated histopathological tool to precisely evaluate bowel fibrosis in patients with Crohn’s disease is lacking. Most of the histopathological assessments that focused on this issue were performed as a part of radiological studies [6,7,8,9,10,11] with various histological grading systems that evaluated bowel fibrosis. In these studies, bowel fibrosis was roughly and semiquantitatively scored according to the deposition depth of collagen fiber within each layer on a microscopic examination, with or without intestinal stricture and/or a proximal dilated lumen on macroscopic evaluation [6,7,8,9,10,11]. To verify the utility of cross-sectional imaging to detect the changes on intestinal fibrosis and the potential efficacy of anti-fibrotic drugs, it is more crucial to quantify the amount of fiber in bowel lesions using histopathology
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