What question did this study set out to answer?

This study aims to assess how endoscopic sampling affects the PICaSSO Histologic Remission Index scoring and histologic remission status in ulcerative colitis biopsies.

January 20, 2026Open Access

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Endoscopic Sampling Impact on PICaSSO Histologic Remission Index Scoring in Ulcerative Colitis

MIMackenzie E. C. ImhoffEli Lilly (United States)GPGenevieve PareckiOregon Health & Science University RBRachel BowenEli Lilly (United States)

Key Points

This study aims to assess how endoscopic sampling affects the PICaSSO Histologic Remission Index scoring and histologic remission status in ulcerative colitis biopsies.
Retrospective evaluation of 128 ulcerative colitis biopsies and 559 sampling bites.
Histological analysis used H&E staining and myeloperoxidase (MPO) immunohistochemistry for neutrophil identification.
Convolutional neural networks analyzed tissue architecture and cytomorphology alongside pathologist interpretations.
Simulation of virtual biopsies to assess sampling impact on PHRI scores.
PHRI MPO scoring showed improved sensitivity and specificity for neutrophil identification compared to PHRI H&E.
CNN-derived PHRI scoring was most accurate for chronic active and ulcerated conditions, with variability in chronic inactive biopsies.
Biopsies with fewer than 5 sampling bites showed significant variability, while those with 5 or more showed limited variability.
Conservative sampling of 5–7 bites led to more accurate assessments of disease activity and remission.

Abstract

ABSTRACT Background Despite histologic remission (HR) being important in management of ulcerative colitis, the impact of endoscopic sampling on newer scoring systems remains uncertain. This study examines the outcome of applying PICaSSO Histologic Remission Index (PHRI) scoring on biopsies collected during routine clinical care and investigates the impact of endoscopic sampling variation on PHRI scoring and HR status. Methods A retrospective survey of UC endoscopic biopsies ( N = 128, 559 bites, 1–13 bites/biopsy) was evaluated using standard H&E stain and myeloperoxidase (MPO) immunohistochemistry to aid neutrophil identification. Convolutional neural networks (CNN), trained on colonic tissue architecture and cytomorphology features, were deployed alongside pathologist interpretations. In silico modeling of bite‐derived virtual biopsies ( N = 19,760) was investigated to determine the impact of sampling variation on PHRI scores and compared with ground truth clinical samples. Results PHRI MPO scoring displayed improved sensitivity and specificity for identifying neutrophils, compared with PHRI H&E . CNN‐derived PHRI scoring was most accurate for chronic active and chronic active with ulceration categories, with greatest variability observed in chronic inactive biopsies. Virtual patient biopsies comprised of < 5 endoscopic bites were impacted most by sampling permutations. Limited variability in PHRI scores was observed in samples consisting of ≥ 5 bites. Conclusions HR status (PHRI = 0) determination was slightly impacted by sampling. Biopsies consisting of < 5 endoscopic bites exhibited the most variability. Conservative sampling of 5–7 endoscopic bites may produce more accurate assessments of microscopic heterogeneity in clinical studies employing quantitative histologic measurements to assess disease activity and remission. Additionally, incorporating MPO increased the sensitivity and specificity of detecting active inflammation for PHRI scoring.

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Cite This Study

Imhoff et al. (Thu,) studied this question.

synapsesocial.com/papers/696f1a239e64f732b51ee775 https://doi.org/https://doi.org/10.1002/jcc5.70008

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