Canavese Gabriella, Villanacci Vincenzo, Sapino Anna, Rocca Rodolfo, Daperno Marco, Suriani Renzo, Maletta Francesca, Cassoni Paola
Pathology Department, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy.
Pathology Department, Spedali Civili di Brescia, Brescia, Italy.
Dig Liver Dis. 2015 Jan;47(1):20-3. doi: 10.1016/j.dld.2014.09.007. Epub 2014 Oct 16.
The diagnosis of inflammatory bowel disease can be challenging and requires the efforts of a multidisciplinary team. We performed a retrospective analysis with the aim of evaluating the adequacy of the prerequisites for arriving at an accurate histological diagnosis.
The following parameters were considered as prerequisites for a diagnosis of inflammatory bowel disease: clinical and endoscopic data; proper sampling and handling of biopsies; and elementary microscopic lesions. We collected 345 cases from 13 centres.
The date of onset and treatment were available for 13% and 16% of the cases, respectively. Endoscopy information was accessible for 77% of the cases. Endoscopic mapping was completed in 13% of the cases. In no cases were the biopsies oriented on acetate strips. The diagnosis was conclusive in 47% of the cases. Activity, epithelial disruption and crypt distortion were described in 35% of the reports with a conclusive diagnosis.
Our study showed that the diagnostic prerequisites were widely unfulfilled, although approximately half of the diagnoses were conclusive for inflammatory bowel disease. Thus, in our assessment of clinical practice: (1) clinicians seldom provide suitable clinical and/or endoscopic information for a histological diagnosis and (2) histopathological diagnoses of inflammatory bowel disease are often not supported by morphology.
炎症性肠病的诊断具有挑战性，需要多学科团队的努力。我们进行了一项回顾性分析，旨在评估做出准确组织学诊断的前提条件是否充分。
以下参数被视为炎症性肠病诊断的前提条件：临床和内镜数据；活检样本的正确采集和处理；以及基本的微观病变。我们从13个中心收集了345例病例。
分别有13%和16%的病例可获得发病日期和治疗信息。77%的病例可获取内镜检查信息。13%的病例完成了内镜定位。无一例活检样本贴于醋酸纤维条上。47%的病例诊断明确。在诊断明确的报告中，35%描述了病变活动度、上皮破坏和隐窝扭曲。
我们的研究表明，尽管约一半的诊断对炎症性肠病具有决定性意义，但诊断前提条件广泛未得到满足。因此，在我们对临床实践的评估中：（1）临床医生很少为组织学诊断提供合适的临床和/或内镜信息；（2）炎症性肠病的组织病理学诊断往往缺乏形态学支持。
