Draft guideline for scoring and reporting interstitial fibrosis l.jpg
This presentation is the property of its rightful owner.
Sponsored Links
1 / 36

Draft guideline for scoring and reporting interstitial fibrosis PowerPoint PPT Presentation


  • 117 Views
  • Uploaded on
  • Presentation posted in: General

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

Download Presentation

Draft guideline for scoring and reporting interstitial fibrosis

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

  • 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

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

Colvin RB Banff 2009


Method l.jpg

Method

  • 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

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

Colvin RB Banff 2009


Slide6 l.jpg

Mostly pathologists

201 Completed survey

96% of those completed form were pathologists

Colvin RB Banff 2009


Slide7 l.jpg

Trichrome most common (97% Masson)

Other stains often used in conjunction with trichrome

Colvin RB Banff 2009


Slide8 l.jpg

Important heterogeneity in definition

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

Colvin RB Banff 2009


Slide9 l.jpg

Banff definition of fibrosis scores (ci)

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?


Slide10 l.jpg

Most score at low power, overall appearance (69%)

Colvin RB Banff 2009


Slide11 l.jpg

Usual exclusions: normal perivascular tissue, subcapsular cortex

Colvin RB Banff 2009


Slide12 l.jpg

Marked heterogeneity in what should be included

Colvin RB Banff 2009


Slide13 l.jpg

Varied consideration of TA in assessment of fibrosis

Colvin RB Banff 2009


Slide14 l.jpg

Confusion on the definition of ci 1

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

Colvin RB Banff 2009


Slide15 l.jpg

Majority report % fibrosis (65%)

Many report ci score (42%)

Colvin RB Banff 2009


Slide16 l.jpg

Pattern but not activity commonly reported

Colvin RB Banff 2009


Slide17 l.jpg

Cellularity most common measure of activity

Colvin RB Banff 2009


Slide18 l.jpg

Visual Trichrome most common for routine use (76%)

Colvin RB Banff 2009


Slide19 l.jpg

Morphometry is a research (64%) not a clinical tool (3%)

Colvin RB Banff 2009


Draft recommendations for scoring and reporting fibrosis l.jpg

DRAFT RECOMMENDATIONS FOR SCORING AND REPORTING FIBROSIS

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 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

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

C. Bellamy, Edinburgh

Colvin RB Banff 2009


Validation l.jpg

VALIDATION

  • 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

  • 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%)

Colvin RB Banff 2009


Slide27 l.jpg

Confusion on what IF/TA score means

?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

Those using morphometry % area less

Colvin RB Banff 2009


Slide29 l.jpg

Maximum varies by definition of fibrosis area

% 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

Colvin RB Banff 2009


Slide31 l.jpg

Clinical trials -visual and morphometry trichrome rec.

Colvin RB Banff 2009


Slide32 l.jpg

Morphometry available to a minority (47%)

Colvin RB Banff 2009


Slide33 l.jpg

Trichrome is most common (42%) for morphometry

Sirius red and collagen III also used

Colvin RB Banff 2009


Slide34 l.jpg

Colvin RB Banff 2009


Clinical trials l.jpg

CLINICAL TRIALS

Visual score As routine, plus

MorphometryAt least one technique:

Trichrome

Sirius red

Collagen III

Colvin RB Banff 2009


Slide36 l.jpg

Range expected:

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

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

Colvin RB Banff 2009


  • Login