Dubian Serge, Yzet Clara, Brazier Franck, Yzet Thierry, Hautefeuille Vincent, Decrombecque Catherine, Bocquillon Quentin, Richard Nicolas, Buisson Anthony, Meynier Jonathan, Fumery Mathurin
Department of Gastroenterology, Amiens University hospital, and Université de Picardie, France.
Department of Radiology, Amiens University hospital, and Université de Picardie, France.
Clin Res Hepatol Gastroenterol. 2025 Mar;49(3):102549. doi: 10.1016/j.clinre.2025.102549. Epub 2025 Feb 3.
We aimed to evaluate the diagnostic accuracy of fecal calprotectin (FC) and intestinal ultrasound (IUS), independently and in combination, as screening tools for adults with suspected IBD to reduce the number of unnecessary endoscopic procedures.
We conducted a retrospective monocentric study that included consecutive adult patients with (i) ileocolonoscopy for suspected IBD between January 2021 and June 2023 who had either (ii) IUS and/or (iii) a FC test within 6 weeks. Bowel wall thickness (BWT) and the color Doppler signal (CDS) were evaluated for all segments. The presence of lymphadenopathy, loss of stratification, stricture, and fistula were also recorded.
In total, 119 patients with a median age of 32 years (IQR, 24.0-41.0) were included. The most common symptoms were abdominal pain (n = 88, 75 %) and chronic diarrhea (n = 89, 75 %). Among the 119 patients, 74 (62 %) had IUS, 101 (82 %) had a FC test, and 56 (47 %) had both. Forty patients (34 %) had a diagnosis of IBD, including 31 (26 %) with CD and 9 (8 %) with UC. By ROC curve analysis, the best threshold of FC to diagnose IBD was 117 ug/g (Se 97 %, Sp 73 %, PPV 67 %, NPV 98 %, AUC 0.88, 95 %CI [0.81; 0.94], p = 0.006). Using this threshold, only 3 % of patients were misclassified as non-IBD. Screening by measuring FC levels would result in a 48 % reduction in the number of adults requiring endoscopy. Abnomal IUS was significantly associated with a diagnosis of IBD (OR 5.6, 95 %IC [2.1;16.2], P = 0.0008). The association of a BWT>3 mm and a positive CDS was associated with a Se, Sp, PPV, and NPV of 48 %, 100 %, 100 %, and 75 %, respectively, but 52 % of patients were misclassified as non-IBD. The combination of a BWT>3 mm, CDS, and FC>117 ug/g had a Se, Sp, PPV, and NPV of 44 %, 100 %, 100 %, and 69 %, respectively. For patients with a normal IUS and FC<117 ug/g, 4 % were misclassified as non-IBD.
The combination of FC and IUS is a useful screening strategy to identify patients who truly require endoscopy for suspected IBD. Calprotectin is a highly effective test for ruling out IBD. Conversely, relying solely on IUS lacks the discriminative power to safely rule out IBD. However, it shows a high PPV and is a potent tool for diagnosing IBD.
我们旨在评估粪便钙卫蛋白（FC）和肠道超声（IUS）单独及联合作为疑似炎症性肠病（IBD）成人患者筛查工具的诊断准确性，以减少不必要的内镜检查数量。
我们进行了一项回顾性单中心研究，纳入了2021年1月至2023年6月期间因疑似IBD接受回结肠镜检查的连续成年患者，这些患者在6周内进行了（ii）IUS和/或（iii）FC检测。对所有肠段评估肠壁厚度（BWT）和彩色多普勒信号（CDS）。还记录了淋巴结病、分层消失、狭窄和瘘管的存在情况。
共纳入119例患者，中位年龄32岁（四分位间距，24.0 - 41.0）。最常见的症状是腹痛（n = 88，75%）和慢性腹泻（n = 89，75%）。119例患者中，74例（62%）进行了IUS检查，101例（82%）进行了FC检测，56例（47%）两者都做了。40例（34%）患者被诊断为IBD，其中31例（26%）为克罗恩病（CD），9例（8%）为溃疡性结肠炎（UC）。通过ROC曲线分析，诊断IBD的FC最佳阈值为117μg/g（敏感性97%，特异性73%，阳性预测值67%，阴性预测值98%，曲线下面积0.88，95%置信区间[0.81; 0.94]，p = （此处原文有误，推测应该是 = 0.0006））。使用该阈值，只有3%的患者被误诊为非IBD。通过检测FC水平进行筛查将使需要内镜检查的成人数量减少48%。异常IUS与IBD诊断显著相关（比值比5.6，95%置信区间[2.1; 16.2]，P = 0.0008）。BWT>3mm和CDS阳性的联合诊断敏感性、特异性、阳性预测值和阴性预测值分别为48%﹑100%﹑100%和75%，但52%的患者被误诊为非IBD。BWT>3mm、CDS和FC>117μg/g的联合诊断敏感性、特异性、阳性预测值和阴性预测值分别为44%﹑100%﹑100%和69%。对于IUS正常且FC<117μg/g的患者，4%被误诊为非IBD。
FC和IUS联合是一种有用的筛查策略，可识别真正需要因疑似IBD进行内镜检查的患者。钙卫蛋白是排除IBD的高效检测方法。相反，仅依靠IUS缺乏安全排除IBD的鉴别能力。然而，它显示出较高的阳性预测值，是诊断IBD的有力工具。
