Histopathology and TB-PCR kit analysis in differentiating the diagnosis of intestinal tuberculosis and Crohn's disease.
OBJECTIVE
To compare the histopathologic features of intestinal tuberculosis (ITB) and Crohn's disease (CD) and to identify whether polymerase chain reaction for Mycobacterium tuberculosis (TB-PCR) would be helpful for differential diagnosis between ITB and CD.


METHODS
We selected 97 patients with established diagnoses (55 cases of ITB and 42 cases of CD) who underwent colonoscopic biopsies. Microscopic features of ITB and CD were reviewed, and eight pathologic parameters were evaluated. Nine cases of acid fast bacilli culture-positive specimens and 10 normal colonic tissue specimens were evaluated as the positive and negative control of the TB-PCR test, respectively. PCR assays were done using two commercial kits: kit <A> detected IS6110 and MPB64, and kit <B> detected IS6110 only; a manual in-house PCR method was also performed on formalin-fixed, paraffin-embedded colonoscopic biopsy specimens.


RESULTS
Statistically significant differences were noted between ITB and CD with regard histopathologic criteria: size of granulomas (P = 0.000), giant cells (P = 0.015), caseation necrosis (P = 0.003), confluent granulomas (P = 0.001), discrete granulomas (P = 0.000), and granulomas with lymphoid cuffs (P = 0.037). However, 29 cases (52.7%) of ITB showed less than five kinds of pathologic parameters, resulting in confusion with CD. The sensitivities and specificities of the TB-PCR test by kit <A>, kit <B>, and the in-house PCR method were 88.9% and 100%, 88.9% and 100%, and 66.7% and 100% in positive and negative controls, respectively. The PCR test done on endoscopic biopsy specimens of ITB and CD were significantly different with kit <A> (P = 0.000) and kit <B> (P = 0.000). The sensitivities and specificities of TB-PCR were 45.5% and 88.1%, 36.4% and 100%, and 5.8% and 100%, for kit <A> and kit <B> and in-house PCR method on endoscopic biopsy specimens. Among the 29 cases of histopathologically confusing CD, 10 cases assayed using kit <A> and 6 cases assayed using kit <B> were TB-PCR positive. A combination of histologic findings and TB-PCR testing led to an increase of diagnostic sensitivity and the increase (from 47.3% to 58.2) was statistically significant with kit <B> (P = 0.000).


CONCLUSIONS
The TB-PCR test combined with histopathologic factors appears to be a helpful technique in formulating the differential diagnosis of ITB and CD in endoscopic biopsy samples.
Jin
Xian-Ji
XJ
Department of Pathology, Inha University Graduate School of Medicine, 7-206 Shinheung-Dong 3 Ga, Joong-Gu, Incheon 400-711, South Korea.
Kim
Joon-Mee
JM
Kim
Hyung-Kil
HK
Kim
Lucia
L
Choi
Suk-Jin
SJ
Park
In-Suh
IS
Han
Jee-Young
JY
Chu
Young-Chae
YC
Song
Ju-Young
JY
Kwon
Kye-Sook
KS
Kim
Eun-Joo
EJ
D000328:Adult; D003424:Crohn Disease / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000235:genetics*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011933:Reagent Kits, Diagnostic; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000473:pathology
D011933:Reagent Kits, Diagnostic