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
Processing time: 93 Days and 1.9 Hours
ARTICLE HIGHLIGHTS
Research background

Some gastrointestinal diseases, including Crohn’s disease (CD), primary intestinal lymphoma (PIL) and intestinal tuberculosis (ITB), can lead to colorectal ulcers, are difficult to differentiate, and usually require entirely different treatments. Their architecture on resection histology can be easily distinguished at low magnification. Endoscopic ultrasound (EUS) can demonstrate bowel wall structural changes, and identify lesions under the mucosa

Research motivation

There are few reports available regarding the value of EUS in the differential diagnosis of these three diseases. The authors attempted to explore the EUS diagnostic accuracy of these diseases and to create a new reliable diagnostic method.

Research objectives

The authors attempted to create an EUS diagnostic classification method which can be used for accurately differentiating CD, PIL, ITB and other colorectal ulcerative diseases.

Research method

The authors searched the in-patient medical record database for confirmed cases of CD, PIL and ITB from 2008 to 2015 at our center, and collected data on EUS from randomly-chosen patients who formed the training set. All cases found to have colorectal ulcers using EUS were obtained from the endoscopy database and formed the test set. The authors then removed the cases which were easily diagnosed, and the remaining cases formed the perplexing test set. The authors conducted univariate logistic regression analysis on the training set to summarize EUS features of CD, PIL and ITB, and created a diagnostic classification method, rediagnosed the cases in the training set, test set and perplexing set using the classification method, and determined EUS diagnostic accuracies. The authors analyzed the origin of the problems, which were reflected from the diagnostic accuracy, adjusted the classification then repeated the rediagnosing and accuracy-calculating steps, obtaining a result which was closer to the facts.

Research results

The EUS features of CD, PIL and ITB are different. The diagnostic classification method, as a new statistical method, is reliable in the differential diagnosis of colorectal ulcerative diseases. But, the case numbers of PIL and ITB were too small.

Research conclusions

EUS is good for differentiating CD, PIL and ITB; An EUS classification system for differentiating CD, PIL and ITB; A new statistical method and an original scoring system.

Research perspectives

The authors will increase the number of ITB and PIL to obtain a higher reliability of the classification method, and will perform a multicenter study.