Kanstrup Fiehn Anne-Marie, Heiberg Engel Peter Johan, Lanzarotto Francesco, Goudkade Danny, Landolfi Stefania, Munck Lars Kristian, Villanacci Vincenzo
Department of Pathology and Department of Surgery, Zealand University Hospital Roskilde, 4000 Roskilde, Denmark; Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark.
Department of Pathology, Zealand University Hospital Roskilde, 4000 Roskilde, Denmark.
Hum Pathol. 2020 Sep;103:63-71. doi: 10.1016/j.humpath.2020.07.011. Epub 2020 Jul 13.
The diagnosis of microscopic colitis (MC) relies on specific histopathological findings in colon biopsies. The number of biopsies needed to diagnose MC remains disputed. The aim of the study was to determine the number and site of biopsies necessary for the diagnosis and the effect of perpendicular orientation when embedding the biopsies. This retrospective multicenter European study included 42 patients with a consensus diagnosis of collagenous colitis (CC), 51 patients with lymphocytic colitis (LC), and three patients with incomplete LC (LCi). The number of individual diagnostic biopsies from each patient was determined. The diagnostic rate of 744 individual biopsies from 96 patients with MC was 69.5% for the specific MC subgroup, 79.4% for MC and 93.4% for MC plus incomplete MC (MCi). The risk of missing a diagnosis of the specific subgroup of MC when analyzing four biopsies was 0.87%, decreasing to 0.18% for MC and 0.0019% for MC plus MCi. More biopsies from the right colon were diagnostic of the specific MC subgroup (76.3% vs. 64.0%, p = 0.0014). Perpendicular orientation of biopsies increased the diagnostic rate of the specific MC subgroup (73.1% vs. 65.0%, p = 0.0201). Histological changes diagnostic of MC were present in almost all biopsies from the right colon, with orientated biopsies more often being diagnostic of the specific MC subgroup. The results of this study indicate that four biopsies from the colon, rectum excluded, are sufficient to diagnose MC.
显微镜下结肠炎（MC）的诊断依赖于结肠活检的特定组织病理学发现。诊断MC所需的活检数量仍存在争议。本研究的目的是确定诊断所需的活检数量和部位，以及活检包埋时垂直定向的影响。这项回顾性多中心欧洲研究纳入了42例经共识诊断为胶原性结肠炎（CC）的患者、51例淋巴细胞性结肠炎（LC）患者和3例不完全性LC（LCi）患者。确定了每位患者的个体诊断性活检数量。96例MC患者的744份个体活检中，特定MC亚组的诊断率为69.5%，MC为79.4%，MC加不完全性MC（MCi）为93.4%。分析4份活检时，漏诊MC特定亚组的风险为0.87%，MC降至0.18%，MC加MCi降至0.0019%。右半结肠的活检对特定MC亚组的诊断率更高（76.3%对64.0%，p = 0.0014）。活检垂直定向提高了特定MC亚组的诊断率（73.1%对65.0%，p = 0.0201）。几乎所有右半结肠活检均存在诊断MC的组织学改变，定向活检更常诊断特定MC亚组。本研究结果表明，从结肠（不包括直肠）取4份活检足以诊断MC。
