Published online Nov 14, 2016. doi: 10.3748/wjg.v22.i42.9411
Peer-review started: June 16, 2016
First decision: July 12, 2016
Revised: July 18, 2016
Accepted: August 19, 2016
Article in press: August 19, 2016
Published online: November 14, 2016
Processing time: 149 Days and 17.8 Hours
To evaluate the usefulness of different parameters to differentiate Crohn’s disease (CD) from primary intestinal lymphoma (PIL).
The medical records of 85 patients with CD and 56 patients with PIL were reviewed retrospectively. Demographic, clinical, laboratory, endoscopic, and computed tomographic enterography (CTE) parameters were collected. The univariate value of each parameter was analyzed. A differentiation model was established by pooling all the valuable parameters. Diagnostic efficacy was analyzed, and a receiver operating characteristic (ROC) curve was plotted.
The demographic and clinical parameters that showed significant values for differentiating CD from PIL included age of onset, symptom duration, presence of diarrhea, abdominal mass, and perianal lesions (P < 0.05). Elevated lactate dehydrogenase and serum β2-microglobulin levels suggested a PIL diagnosis (P < 0.05). The endoscopic parameters that showed significant values for differentiating CD from PIL included multiple-site lesions, longitudinal ulcer, irregular ulcer, and intraluminal proliferative mass (P < 0.05). The CTE parameters that were useful in the identification of the two conditions included involvement of ≤ 3 segments, circular thickening of the bowel wall, wall thickness > 8 mm, aneurysmal dilation, stricture with proximal dilation, “comb sign”, mass showing the “sandwich sign”, and intussusceptions (P < 0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the differentiation model were 91.8%, 96.4%, 93.6%, 97.5%, and 88.5%, respectively. The cutoff value was 0.5. The area under the ROC curve was 0.989.
The differentiation model that integrated the various parameters together may yield a high diagnostic efficacy in the differential diagnosis between CD and PIL.
Core tip: Crohn’s disease and primary intestinal lymphoma (PIL) have overlapping clinical manifestations. Misdiagnosis of PIL would lead to disastrous outcomes in patients. Consequently, the differential diagnosis between these two conditions has perplexed clinical practitioners for decades. In this article, we evaluated the usefulness of different parameters, including clinical manifestations, laboratory tests, endoscopic features, and computed tomographic enterographic characteristics for differentiating these two conditions and established an objective differentiation model that would yield a high diagnostic efficacy in order to avoid misdiagnosis of PIL. This is a first study which focuses on the differential diagnosis of these two diseases.