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. 1991 Dec;32(12):1514–1520. doi: 10.1136/gut.32.12.1514

Histopathological evaluation of colonic mucosal biopsy specimens in chronic inflammatory bowel disease: diagnostic implications.

C A Seldenrijk 1, B C Morson 1, S G Meuwissen 1, N W Schipper 1, J Lindeman 1, C J Meijer 1
PMCID: PMC1379253  PMID: 1773958

Abstract

In a prospective blind evaluation of multiple colonic mucosal biopsy specimens, 45 clinically well defined patients with chronic inflammatory bowel disease (21 Crohn's disease and 24 ulcerative colitis) and 16 control subjects (seven normal subjects and nine patients with diverticular disease) were studied to identify reproducible histopathological features which could distinguish chronic inflammatory bowel disease (CIBD) from non-CIBD and Crohn's disease from ulcerative colitis. Using kappa statistics 16 of 41 histological features were sufficiently reproducible for further stepwise discriminant analysis to differentiate between CIBD and non-CIBD, and between Crohn's disease and ulcerative colitis. Using the combination of three features (an increase of lymphocytes and plasma cells in the lamina propria, the presence of branching of crypts, and neutrophils in the crypt epithelium) we were able to distinguish CIBD from non-CIBD in 89% of the cases with high probability (p greater than 0.85). To separate Crohn's disease from ulcerative colitis three features (an excess of histiocytes in combination with a villous or irregular aspect of the mucosal surface and granulomas) had a high predictive value. Using these features 70% of Crohn's disease patients and 75% of ulcerative colitis patients were correctly classified with a high probability (p greater than 0.85). These findings indicate that the pathologist is dependent on the presence of only a few histological features for a reliable classification of Crohn's disease and ulcerative colitis.

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Selected References

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  1. Cook M. G., Dixon M. F. An analysis of the reliability of detection and diagnostic value of various pathological features in Crohn's disease and ulcerative colitis. Gut. 1973 Apr;14(4):255–262. doi: 10.1136/gut.14.4.255. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Frei J. V., Morson B. C. Medical audit of rectal biopsy diagnosis of inflammatory bowel disease. J Clin Pathol. 1982 Mar;35(3):341–344. doi: 10.1136/jcp.35.3.341. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Giard R. W., Hermans J., Ruiter D. J., Hoedemaeker P. J. Variations in histopathological evaluation of non-neoplastic colonic mucosal abnormalities; assessment and clinical significance. Histopathology. 1985 May;9(5):535–541. doi: 10.1111/j.1365-2559.1985.tb02834.x. [DOI] [PubMed] [Google Scholar]
  4. Goldman H. Acute versus chronic colitis: how and when to distinguish by biopsy. Gastroenterology. 1984 Jan;86(1):199–201. [PubMed] [Google Scholar]
  5. Green F. H., Fox H. The distribution of mucosal antibodies in the bowel of patients with Crohn's disease. Gut. 1975 Feb;16(2):125–131. doi: 10.1136/gut.16.2.125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Harvey R. F., Bradshaw J. M. A simple index of Crohn's-disease activity. Lancet. 1980 Mar 8;1(8167):514–514. doi: 10.1016/s0140-6736(80)92767-1. [DOI] [PubMed] [Google Scholar]
  7. Hill R. B., Kent T. H., Hansen R. N. Clinical usefulness of rectal biopsy in Crohn's disease. Gastroenterology. 1979 Oct;77(4 Pt 2):938–944. [PubMed] [Google Scholar]
  8. Jenkins D., Goodall A., Drew K., Scott B. B. What is colitis? Statistical approach to distinguishing clinically important inflammatory change in rectal biopsy specimens. J Clin Pathol. 1988 Jan;41(1):72–79. doi: 10.1136/jcp.41.1.72. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Korelitz B. I., Sommers S. C. Differential diagnosis of ulcerative and granulomatous colitis by sigmoidoscopy, rectal biopsy and cell counts of rectal mucosa. Am J Gastroenterol. 1974 Jun;61(6):460–469. [PubMed] [Google Scholar]
  10. Landis J. R., Koch G. G. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar;33(1):159–174. [PubMed] [Google Scholar]
  11. Lennard-Jones J. E., Lockhart-Mummery H. E., Morson B. C. Clinical and pathological differentiation of Crohn's disease and proctocolitis. Gastroenterology. 1968 Jun;54(6):1162–1170. [PubMed] [Google Scholar]
  12. McGovern V. J., Goulston S. J. Crohn's disease of the colon. Gut. 1968 Apr;9(2):164–176. doi: 10.1136/gut.9.2.164. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Meuwissen S. G., Feltkamp-Vroom T. M., De La Rivière A. B., Von Dem Borne A. E., Tytgat G. N. Analysis of the lympho-plasmacytic infiltrate in Crohn's disease with special reference to identification of lymphocyte-subpopulations. Gut. 1976 Oct;17(10):770–780. doi: 10.1136/gut.17.10.770. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Morson B. C. Histopathology of Crohn's disease. Scand J Gastroenterol. 1971;6(7):573–575. doi: 10.3109/00365527109181136. [DOI] [PubMed] [Google Scholar]
  15. Morson B. C. Rectal and colonic biopsy in inflammatory bowel disease. Am J Gastroenterol. 1977 May;67(5):417–426. [PubMed] [Google Scholar]
  16. Nostrant T. T., Kumar N. B., Appelman H. D. Histopathology differentiates acute self-limited colitis from ulcerative colitis. Gastroenterology. 1987 Feb;92(2):318–328. doi: 10.1016/0016-5085(87)90124-7. [DOI] [PubMed] [Google Scholar]
  17. Riddell R. H., Goldman H., Ransohoff D. F., Appelman H. D., Fenoglio C. M., Haggitt R. C., Ahren C., Correa P., Hamilton S. R., Morson B. C. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol. 1983 Nov;14(11):931–968. doi: 10.1016/s0046-8177(83)80175-0. [DOI] [PubMed] [Google Scholar]
  18. Robertson A. J., Anderson J. M., Beck J. S., Burnett R. A., Howatson S. R., Lee F. D., Lessells A. M., McLaren K. M., Moss S. M., Simpson J. G. Observer variability in histopathological reporting of cervical biopsy specimens. J Clin Pathol. 1989 Mar;42(3):231–238. doi: 10.1136/jcp.42.3.231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Rosekrans P. C., Meijer C. J., van der Wal A. M., Cornelisse C. J., Lindeman J. Immunoglobulin containing cells in inflammatory bowel disease of the colon: a morphometric and immunohistochemical study. Gut. 1980 Nov;21(11):941–947. doi: 10.1136/gut.21.11.941. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Rotterdam H., Korelitz B. I., Sommers S. C. Microgranulomas in grossly normal rectal mucosa in Crohn's disease. Am J Clin Pathol. 1977 Jun;67(6):550–554. doi: 10.1093/ajcp/67.6.550. [DOI] [PubMed] [Google Scholar]
  21. Schroeder K. W., Tremaine W. J., Ilstrup D. M. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987 Dec 24;317(26):1625–1629. doi: 10.1056/NEJM198712243172603. [DOI] [PubMed] [Google Scholar]
  22. Scott B. B., Goodall A., Stephenson P., Jenkins D. Rectal mucosal plasma cells in inflammatory bowel disease. Gut. 1983 Jun;24(6):519–524. doi: 10.1136/gut.24.6.519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Silcocks P. B. Measuring repeatability and validity of histological diagnosis--a brief review with some practical examples. J Clin Pathol. 1983 Nov;36(11):1269–1275. doi: 10.1136/jcp.36.11.1269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Sommers S. C., Korelitz B. I. Mucosal-cell counts in ulcerative and granulomatous colitis. Am J Clin Pathol. 1975 Mar;63(3):359–365. doi: 10.1093/ajcp/63.3.359. [DOI] [PubMed] [Google Scholar]
  25. Stenkvist B., Bengtsson E., Eriksson O., Jarkrans T., Nordin B., Westman-Naeser S. Histopathological systems of breast cancer classification: reproducibility and clinical significance. J Clin Pathol. 1983 Apr;36(4):392–398. doi: 10.1136/jcp.36.4.392. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Surawicz C. M., Belic L. Rectal biopsy helps to distinguish acute self-limited colitis from idiopathic inflammatory bowel disease. Gastroenterology. 1984 Jan;86(1):104–113. [PubMed] [Google Scholar]
  27. Surawicz C. M., Meisel J. L., Ylvisaker T., Saunders D. R., Rubin C. E. Rectal biopsy in the diagnosis of Crohn's disease: value of multiple biopsies and serial sectioning. Gastroenterology. 1981 Jan;80(1):66–71. [PubMed] [Google Scholar]
  28. Thomas G. D., Dixon M. F., Smeeton N. C., Williams N. S. Observer variation in the histological grading of rectal carcinoma. J Clin Pathol. 1983 Apr;36(4):385–391. doi: 10.1136/jcp.36.4.385. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. van Spreeuwel J. P., Meijer C. J., Rosekrans P. C., Lindeman J. Immunoglobulin-containing cells in gastrointestinal pathology--diagnostic applications. Pathol Annu. 1986;21(Pt 1):295–310. [PubMed] [Google Scholar]

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