Crohn's Disease Features in Anastomotic Biopsies from Patients With and Without Crohn's Disease: Diagnostic and Prognostic Value.

Autor:	Evaristo G; Department of Pathology, University of Chicago, Chicago, Illinois., Szczepanski J; Department of Pathology, University of Michigan, Ann Arbor, Michigan., Farag MS; Department of Pathology, McGill University, Montreal, Quebec, Canada., Rubin DT; Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Ilinois., Campbell LK; Northwest Arkansas Pathology Associates, Fayetteville, Arkansas., Marcus VA; Department of Pathology, McGill University, Montreal, Quebec, Canada., Lamps LW; Department of Pathology, University of Michigan, Ann Arbor, Michigan., Hart J; Department of Pathology, University of Chicago, Chicago, Illinois. Electronic address: john.hart@bsd.uchicago.edu.
Jazyk:	angličtina
Zdroj:	Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc [Mod Pathol] 2023 Nov; Vol. 36 (11), pp. 100325. Date of Electronic Publication: 2023 Sep 03.
DOI:	10.1016/j.modpat.2023.100325
Abstrakt:	Endoscopic evidence of disease activity is a critical predictor of clinical relapse in patients with Crohn's disease (CD), and histologic disease activity is evolving as a similarly important end point for patient management. However, classical morphologic features of CD may overlap with postoperative inflammatory changes, confounding the evaluation of anastomotic biopsies. There is a clear unmet need for better characterization of diagnostic and clinically significant histologic features of CD in these surgically altered sites. We evaluated ileocolonic and colocolonic/rectal anastomotic biopsies performed at 3 academic institutions in patients with and without CD. The biopsies were blindly assessed for CD histologic features and correlated to clinical and endoscopic characteristics. In CD patients, the presence of each feature was correlated with the subsequent clinical exacerbation or relapse. We obtained anastomotic biopsies from 208 patients, of which 109 were operated on for CD and 99 for another indication (neoplasia [80%], diverticular disease (11%), and other [9%]). Mean time since surgery was 10 years (0-59; 14 years for CD [1-59], 6 years for non-CD [0-33]). Endoscopic inflammation was noted in 52% of cases (68% for CD and 35% for non-CD). Microscopic inflammation was present in 74% of cases (82% for CD and 67% for non-CD). Only discontinuous lymphoplasmacytosis (P < .001) and pyloric gland metaplasia (P = .04) occurred significantly more often in CD patients. However, none of the histologic features predicted clinical disease progression. In subset analysis, the presence of histologic features of CD in nonanastomotic biopsies obtained concurrently in CD patients was significantly associated with relapse (P = .03). Due to extensive morphologic overlap between CD and postoperative changes and the lack of specific histologic features of relapse, biopsies from anastomotic sites are of no value in predicting clinical CD progression. Instead, CD activity in biopsies obtained away from anastomotic sites should be used for guiding endoscopic sampling and clinical management. (Copyright © 2023 United States & Canadian Academy of Pathology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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