Histology Matrix • Nancy Scoring Protocol
Biopsy Grade
Select the histological grade from the pathology report to visualize the mucosal healing status.
Guidelines & Evidence
Verified
Last Review: 2026-07-17
When to Use
When to Use
Standardized histological assessment of mucosal healing in Ulcerative Colitis (UC)
To define the target of "Histological Remission" (NHI ≤ 1)
Research-grade evaluation of biopsy specimens following therapeutic induction
Predicting the risk of future clinical relapse even in patients with endoscopic remission
Histological vs. Endoscopic Healing
Clinical guidelines (STRIDE-II) now recognize histological remission as a "secondary" target. Achieving histological remission (Grade 0 or 1) is associated with superior outcomes compared to achieving only endoscopic remission (Mayo 0).
How it Works
The 5 Grade Scale (0–4)
01
Grade 0: No significant inflammation.
02
Grade 1: Chronic inflammatory infiltrate (plasma cells/lymphocytes) but no neutrophils.
03
Grade 2: Mild active inflammation (neutralphilic infiltrate in the lamina propria).
04
Grade 3: Moderate-to-severe active inflammation (neutrophils in the crypts).
05
Grade 4: Ulceration (Presence of superficial fibrin/granulation tissue).
Diagnostic Thresholds
| Grade 0 or 1 | Histological Remission |
| Grade ≥ 2 | Active Histological Disease |
Clinical Pearls
Nancy vs. Robarts vs. Geboes
The Nancy Index is significantly simpler and easier to implement in clinical practice than the complex Geboes score. It has extremely high inter-observer reliability, making it the preferred choice for many recent clinical trials of JAK inhibitors and S1P modulators.
The Neutrophil Rule
The Presence of even a single neutrophil (Grade 2+) precludes the diagnosis of histological remission. Neutrophils are the "active" marker of imminent mucosal injury.
Clinical Pearls
NHI Grade 4 (Ulceration) is the histological correlate of the endoscopic Mayo Grade 3
Patients in histological remission have a 2-3x lower risk of hospitalization over 3 years compared to those with "Endoscopic-only" remission
Nancy score was the first to be validated specifically for reproducibility between expert and general pathologists
Next Steps
Clinical Triage
01
NHI ≥ 2: Active inflammation. Consider dose-optimization if symptoms or biomarkers (calprotectin) are also elevated.
02
NHI ≤ 1: Success. Deep mucosal healing achieved.
Complementary Scoring
Mayo Endoscopic Subscore (MES)
Robarts Histopathology Index (RHI)
Geboes Score (Detailed Histology)
The Evidence
The Defining Paper
Development and validation of the Nancy histological index for UC.
Marchal-Bressenot A et al. • Gut. 2017;66(1):43-49. The development and rigorous validation study.
View Source• . ;
Clinical Utility Review
ECCO Position Paper: Harmonization of biopsy specimens in IBD.
Magro F et al. • Journal of Crohn's and Colitis. 2020;14(11):1503-1519. Supporting Nancy for routine use.
View SourceOrigins & History
Nancy, France
Developed by the IBD research group in Nancy, France (led by Professor Laurent Peyrin-Biroulet). It was specifically designed to be the UC equivalent of the "Simple Endoscopic Score," prioritizing accuracy and ease of use over morphological minutiae.
Last Comprehensive Review: 2026-07-17