Inflamm Bowel Dis. 2021 Jun 9;izab122. doi: 10.1093/ibd/izab122. Online ahead of print.

Niels Vande Casteele ¹, Jonathan A Leighton ², Shabana F Pasha ², Frank Cusimano ², Aart Mookhoek ³, Catherine E Hagen ⁴, Christophe Rosty ^5 6, Reetesh K Pai ⁷, Rish K Pai ⁸

Author information

• ¹Department of Medicine, University of California San Diego, La Jolla, California, USA.
• ²Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
• ³Department of Pathology, VU Medical Center, Amsterdam, the Netherlands.
• ⁴Department of Pathology and Laboratory Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA.
• ⁵Envoi Specialist Pathologists, Brisbane, Queensland, Australia.
• ⁶Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
• ⁷Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
• ⁸Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA.

Abstract

Background: Eosinophils have been implicated in the pathogenesis of ulcerative colitis and have been associated with disease course and therapeutic response. However, associations between eosinophil density, histologic activity, and clinical features have not been rigorously studied.

Methods: A deep learning algorithm was trained to identify eosinophils in colonic biopsies and validated against pathologists' interpretations. The algorithm was applied to sigmoid colon biopsies from a cross-sectional cohort of 88 ulcerative colitis patients with histologically active disease as measured by the Geboes score and Robarts histopathology index (RHI). Associations between eosinophil density, histologic activity, and clinical features were determined.

Results: The eosinophil deep learning algorithm demonstrated almost perfect agreement with manual eosinophil counts determined by 4 pathologists (interclass correlation coefficients: 0.805-0.917). Eosinophil density varied widely across patients (median 113.5 cells per mm2, interquartile range 108.9). There was no association between eosinophil density and RHI (P = 0.5). Significant differences in eosinophil density were seen between patients with Montreal E3 vs E2 disease (146.2 cells per mm2 vs 88.2 cells per mm2, P = 0.005). Patients on corticosteroids had significantly lower eosinophil density (62.9 cells per mm2 vs 124.1 cells per mm2, P = 0.006). No association between eosinophil density and biologic use was observed (P = 0.5).

Conclusions: We developed a deep learning algorithm to quantify eosinophils in colonic biopsies. Eosinophil density did not correlate with histologic activity but did correlate with disease extent and corticosteroid use. Future studies applying this algorithm in larger cohorts with longitudinal follow-up are needed to further elucidate the role of eosinophils in ulcerative colitis.