Draft guideline for scoring and reporting interstitial fibrosis
Download
1 / 36

Draft guideline for scoring and reporting interstitial fibrosis - PowerPoint PPT Presentation


  • 135 Views
  • Uploaded on

Draft guideline for scoring and reporting interstitial fibrosis. Working Group on Fibrosis Banff 09. Colvin RB B a nff 2009. Rationale. Interstitial fibrosis correlates with function and prognosis in many studies of native and transplant kidneys

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Draft guideline for scoring and reporting interstitial fibrosis' - sirius


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Draft guideline for scoring and reporting interstitial fibrosis l.jpg

Draft guideline for scoring and reporting interstitial fibrosis

Working Group on Fibrosis

Banff 09

Colvin RB Banff 2009


Rationale l.jpg
Rationale fibrosis

  • Interstitial fibrosis correlates with function and prognosis in many studies of native and transplant kidneys

  • Reproducibility of pathology assessment of fibrosis is modest at best

  • Definitions and methodology are variable

  • Fibrosis is an endpoint in some clinical trials and a potential surrogate marker of efficacy

Colvin RB Banff 2009


Purpose l.jpg
Purpose fibrosis

  • Promote more uniform reporting of interstitial fibrosis, quantitation and reproducibility for routine use and clinical trials

Colvin RB Banff 2009


Method l.jpg
Method fibrosis

  • Survey pathologists and nephrologists on current practice

  • Develop guidelines based on these practices and discussion

  • Validate recommendations

Colvin RB Banff 2009


Banff fibrosis survey results l.jpg
Banff Fibrosis Survey Results fibrosis

7/22/09-8/11/09 Nephnppt/RPS/WGN

Colvin RB Banff 2009


Slide6 l.jpg

Mostly pathologists fibrosis

201 Completed survey

96% of those completed form were pathologists

Colvin RB Banff 2009


Slide7 l.jpg

Trichrome most common (97% Masson) fibrosis

Other stains often used in conjunction with trichrome

Colvin RB Banff 2009


Slide8 l.jpg

Important heterogeneity in definition fibrosis

Those using % area more commonly had morphometry access (59% vs 41%)

Colvin RB Banff 2009


Slide9 l.jpg

Banff definition of fibrosis scores (ci) fibrosis

Grade I (mild) Mild interstitial fibrosis and tubular atrophy

(<25% of cortical area)

Grade II (moderate) Moderate interstitial fibrosis and tubular atrophy (26-50% of cortical area)

Grade III (severe) Severe interstitial fibrosis and tubular atrophy/loss

(>50% of cortical area)

Is mild but diffuse (>50%) fibrosis ci3?






Slide14 l.jpg

Confusion on the definition of ci 1 cortex

<50% got the correct answer (6-25)

Colvin RB Banff 2009


Slide15 l.jpg

Majority report % fibrosis (65%) cortex

Many report ci score (42%)

Colvin RB Banff 2009


Slide16 l.jpg

Pattern but not activity commonly reported cortex

Colvin RB Banff 2009


Slide17 l.jpg

Cellularity most common measure of activity cortex

Colvin RB Banff 2009




Draft recommendations for scoring and reporting fibrosis l.jpg
DRAFT RECOMMENDATIONS FOR SCORING AND REPORTING FIBROSIS cortex

Fibrosis is defined as abnormal accumulation of

fibrillar collagen and associated matrix proteins in the cortical interstitium

Colvin RB Banff 2009


Routine practice scoring l.jpg
ROUTINE PRACTICE cortex Scoring

Stain: Trichrome (Masson) (+PAS/H&E/silver)

Thickness: 2-4 microns

Assessment: Global low power (4-10x), Alternate: Average 20x fields

Definition of area: % of cortex affected by fibrosis, Alternate: % area of cortical fibrous tissue by morphometry

Include: Cortical interstitium of cortex bounded by glomeruli

Areas of tubular loss with minimal fibrosis

Periglomerular fibrosis

Exclude: Subcapsular cortex

Normal fibrous tissue around arteries

Areas with inflammation without fibrosis

Colvin RB Banff 2009


Reporting l.jpg
Reporting cortex

Extent: % fibrosis to nearest 5% (or 10%) + Banff ci

Pattern: Focal, multifocal, diffuse

other terms (to be defined): Loose, dense, striped, periglomerular, subcapsular…

Activity: Presence of mononuclear infiltrate in fibrotic areas

Evolution: Note comparison with last prior biopsy

Normal cortex: % of cortex without fibrosis or tubular atrophy

Colvin RB Banff 2009


Slide23 l.jpg

Guide for scoring interstitial fibrosis in renal biopsies cortex

C. Bellamy, Edinburgh

Colvin RB Banff 2009


Validation l.jpg
VALIDATION cortex

  • Recommended visual scoring method will be validated by an open multicenter trial

  • ~30 biopsies evaluated in scanned whole slides.

  • Participation open (Banff, RPS, WGN pathologists).

  • Will include transplant and native kidney biopsies.

Colvin RB Banff 2009


Validation25 l.jpg
VALIDATION cortex

  • Virtual slides (Trichrome and PAS) hosted on a web site in Edmonton

  • Two phases: a training set and a validation set of 10 and 30 cases, respectively

  • Scores will be entered via the ”Surveymonkey” system used for the fibrosis survey

  • Other centers are encouraged to provide a few cases each (either as Aperio scans or by sending slides to Michael Mengel to be scanned in Edmonton)

  • Cases will be presented with a trichrome and a PAS, at least 7 glomeruli (two cores preferred but not necessary. Native or transplant biopsy, with a wide range of fibrosis (0-100%).


Slide26 l.jpg

2-4 micron sections most common (90%) cortex

Colvin RB Banff 2009


Slide27 l.jpg

Confusion on what IF/TA score means cortex

?Sum of ci and ct

?Average ci and ct

?Higher of ci or ct

Colvin RB Banff 2009

Colvin RB Banff 2009


Slide28 l.jpg

Highly variable maximum cortex

Those using morphometry % area less

Colvin RB Banff 2009


Slide29 l.jpg

Maximum varies by definition of fibrosis area cortex

% cortical area (~morphometry)

% involved cortex

41%

Access to morph facilities

59%

Colvin RB Banff 2009


Slide30 l.jpg

5% most common as upper limit of normal cortex

Colvin RB Banff 2009



Slide32 l.jpg

Morphometry available to a minority (47%) cortex

Colvin RB Banff 2009


Slide33 l.jpg

Trichrome is most common (42%) for morphometry cortex

Sirius red and collagen III also used

Colvin RB Banff 2009


Slide34 l.jpg

Colvin RB B cortexanff 2009


Clinical trials l.jpg
CLINICAL TRIALS cortex

Visual score As routine, plus

Morphometry At least one technique:

Trichrome

Sirius red

Collagen III

Colvin RB Banff 2009


Slide36 l.jpg

Range expected: cortex

Maximum 100% (less with morph method). <5% = normal

Normal cortex: Score % of cortex without fibrosis or tubular atrophy

Colvin RB Banff 2009


ad