Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2017; 23(46): 8207-8216
Published online Dec 14, 2017. doi: 10.3748/wjg.v23.i46.8207
Diagnostic classification of endosonography for differentiating colorectal ulcerative diseases: A new statistical method
En-Qi Qiu, Wen Guo, Tian-Ming Cheng, Yong-Li Yao, Wei Zhu, Si-De Liu, Fa-Chao Zhi
En-Qi Qiu, Wen Guo, Tian-Ming Cheng, Yong-Li Yao, Wei Zhu, Si-De Liu, Fa-Chao Zhi, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Institute of Digestive Diseases of Guangdong Province, Guangdong Provincial Key Laboratory of Gastroenterology, Guangzhou 510515, Guangdong Province, China
Author contributions: Qiu EQ and Guo W designed the study; Qiu EQ collected the cases; Guo W and Cheng TM evaluated the endoscopic ultrasound images; Qiu EQ recorded and analyzed the data; Guo W, Yao YL and Zhu W interpreted the results of analysis; Qiu EQ wrote the paper; Guo W and Zhi FC revised the manuscript; Liu SD and Zhi FC approved the final version and coordinated all aspects of work; Liu SD and Zhi FC approved the final version and coordinated all aspects of work.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Nanfang Hospital, Southern Medical University.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fa-Chao Zhi, MD, Professor, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Institute of Digestive Diseases of Guangdong Province, Guangdong Provincial Key Laboratory of Gastroenterology, Dadao North No. 1838, Guangzhou 510515, Guangdong Province, China. zhifc@smu.edu.cn
Telephone: +86-20-61641532 Fax: +86-20-87280770
Received: September 10, 2017
Peer-review started: September 10, 2017
First decision: September 20, 2017
Revised: October 13, 2017
Accepted: November 7, 2017
Article in press: November 7, 2017
Published online: December 14, 2017
Abstract
AIM

To establish a classification method for differential diagnosis of colorectal ulcerative diseases, especially Crohn’s disease (CD), primary intestinal lymphoma (PIL) and intestinal tuberculosis (ITB).

METHODS

We searched the in-patient medical record database for confirmed cases of CD, PIL and ITB from 2008 to 2015 at our center, collected data on endoscopic ultrasound (EUS) from randomly-chosen patients who formed the training set, conducted univariate logistic regression analysis to summarize EUS features of CD, PIL and ITB, and created a diagnostic classification method. All cases found to have colorectal ulcers using EUS were obtained from the endoscopy database and formed the test set. We then removed the cases which were easily diagnosed, and the remaining cases formed the perplexing test set. We re-diagnosed the cases in the three sets using the classification method, determined EUS diagnostic accuracies, and adjusted the classification accordingly. Finally, the re-diagnosing and accuracy-calculating steps were repeated.

RESULTS

In total, 272 CD, 60 PIL and 39 ITB cases were diagnosed from 2008 to 2015 based on the in-patient database, and 200 CD, 30 PIL and 20 ITB cases were randomly chosen to form the training set. The EUS features were summarized as follows: CD: Thickened submucosa with a slightly high echo level and visible layer; PIL: Absent layer and diffuse hypoechoic mass; and ITB: Thickened mucosa with a high or slightly high echo level and visible layer. The test set consisted of 77 CD, 30 PIL, 23 ITB and 140 cases of other diseases obtained from the endoscopy database. Seventy-four cases were excluded to form the perplexing test set. After adjustment of the classification, EUS diagnostic accuracies for CD, PIL and ITB were 83.6% (209/250), 97.2% (243/250) and 85.6% (214/250) in the training set, were 89.3% (241/270), 97.8% (264/270) and 84.1% (227/270) in the test set, and were 86.7% (170/196), 98.0% (192/196) and 85.2% (167/196) in the perplexing set, respectively.

CONCLUSION

The EUS features of CD, PIL and ITB are different. The diagnostic classification method is reliable in the differential diagnosis of colorectal ulcerative diseases.

Keywords: Endoscopic ultrasound, Ulcerative diseases, Crohn’s disease, Primary intestinal lymphoma, Intestinal tuberculosis, Classification

Core tip: A classification method was created for the differential diagnosis of Crohn’s disease (CD), primary intestinal lymphoma (PIL) and intestinal tuberculosis (ITB) by endoscopic ultrasound (EUS), and yielded good results. The classification was designed based on univariate logistic regression analysis of EUS features of CD, PIL and ITB. This classification method is useful for diagnosing these three diseases in daily EUS practice.