Differential Diagnosis of Crohn's Disease and Ulcerative Primary Intestinal Lymphoma: A Scoring Model Based on a Multicenter Study

Hong Yang; Huimin Zhang; Wei Liu; Bei Tan; Tao Guo; Xiang Gao; Rui Feng; Kaichun Wu; Qian Cao; Zhihua Ran; Zhanju Liu; Naizhong Hu; Liangru Zhu; Yamin Lai; Congling Wang; Wei Han; Jiaming Qian

doi:10.3389/fonc.2022.856345

Differential Diagnosis of Crohn's Disease and Ulcerative Primary Intestinal Lymphoma: A Scoring Model Based on a Multicenter Study

Front Oncol. 2022 May 2:12:856345. doi: 10.3389/fonc.2022.856345. eCollection 2022.

Authors

Hong Yang¹, Huimin Zhang¹, Wei Liu², Bei Tan¹, Tao Guo¹, Xiang Gao³, Rui Feng⁴, Kaichun Wu⁵, Qian Cao⁶, Zhihua Ran⁷, Zhanju Liu⁸, Naizhong Hu⁹, Liangru Zhu¹⁰, Yamin Lai¹, Congling Wang¹, Wei Han¹¹, Jiaming Qian¹

Affiliations

¹ Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Radiology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁴ Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁵ State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
⁶ Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou, China.
⁷ Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health; Shanghai Inflammatory Bowel Disease Research Center; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁸ Department of Gastroenterology, The Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
⁹ Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
¹⁰ Department of Gastroenterology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹¹ Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, School of Basic Medicine, Beijing, China.

Abstract

Background: Differential diagnosis of Crohn's disease (CD) and ulcerative primary intestinal lymphoma (UPIL) is a tough problem in clinical practice.

Aims: Our study identified key differences between CD and UPIL patients and aimed to further establish a scoring model for differential diagnosis.

Methods: A total of 91 CD and 50 UPIL patients from 9 tertiary inflammatory bowel disease centers were included. Univariate and multivariate analyses were used to determine significant markers for differentiating CD and UPIL. A differential scoring model was established by logistic regression analysis.

Results: The differential model was based on clinical symptoms, endoscopic and imaging features that were assigned different scores: intestinal bleeding (-2 points), extraintestinal manifestation (2 points), segmental lesions (1 point), cobblestone sign (2 points), homogeneous enhancement (-1 point), mild enhancement (-1 point), engorged vasa recta (1 point). A total score of ≥1 point indicates CD, otherwise UPIL was indicated. This model produced an accuracy of 83.66% and an area under the ROC curve of 0.947. The area under the ROC curve for validation using the 10-fold validation method was 0.901.

Conclusion: This study provided a convenient and useful model to differentiate CD from UPIL.

Keywords: Crohn’s disease; diagnosis; imaging; scoring model; ulcerative primary intestinal lymphoma.