title: Confluent granulomas and ulcers lined by epithelioid histiocytes: new ideal method for differentiation of ITB and CD? A meta analysis.
abstract: BACKGROUND
  There are few widely accepted criteria other than caseation, which has low sensitivity, for differentiating intestinal tuberculosis (ITB) and Crohn's disease (CD).
  
  
  OBJECTIVE
  We performed a meta-analysis to evaluate the use of confluent granulomas and ulcers lined by epithelioid histiocytes as histological methods for differentiating ITB and CD, compared with that of caseation.
  
  
  METHODS
  We searched PubMed, Medline, Embase, Web of Science, the Cochrane Library and Chinese Biomedicine Database for all relevant studies on the histological differentiation of ITB and CD. Sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for each study. Study quality and heterogeneity were assessed. Meta-regression analysis and sensitivity analyses were performed.
  
  
  RESULTS
  Ten randomized trials involving 316 ITB and 376 CD patients were included. The results showed that analysis of caseation showed an overall weighted area under the curve (AUC) of 0.9966, overall sensitivity and specificity were 0.21 and 1.00, respectively, with a positive likelihood ratio (+LR) of 10.79, negative likelihood ratio(-LR) of 0.82 and DOR of 13.74. Confluent granulomas had a lower overall weighted AUC of 0.9381, sensitivity and specificity were 0.38 and 0.99, respectively, with a +LR of 16.29, -LR of 0.65 and DOR of 26.52. Overall weighted AUC for ulcers lined by epithelioid histiocytes was 0.9017, sensitivity and specificity were 0.41 and 0.94, respectively, with a +LR of 6.46, -LR of 0.54 and DOR of 13.17. Significant heterogeneity was noted for the studies. Meta-regression analysis showed that study source, publication year, size, design and quality did not affect heterogeneity.
  
  
  CONCLUSIONS
  Confluent granulomas and ulcers lined by epithelioid histiocytes are helpful in distinguishing ITB from CD, which may provide a new method, other than caseating granulomas and acid-fast bacilli, to differentiate ITB and CD in mucosal biopsies.
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Du
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: Yan-Yan
authors.initials: YY
authors.lastname: Ma
authors.affiliation: Department of Pathology, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: Ha
authors.initials: H
authors.lastname: Xiang
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: You-Ming
authors.initials: YM
authors.lastname: Li
mesh_terms: D019540:Area Under Curve; D001706:Biopsy / Q000379:methods; D002454:Cell Differentiation / Q000502:physiology*; D003424:Crohn Disease / Q000473:pathology*; D015622:Epithelioid Cells / Q000473:pathology*; D006099:Granuloma / Q000473:pathology*; D006644:Histiocytes / Q000473:pathology*; D006801:Humans; D016017:Odds Ratio; D012680:Sensitivity and Specificity; D014385:Tuberculosis, Gastrointestinal / Q000473:pathology*; D014456:Ulcer / Q000473:pathology*