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Abstract
Summary
There is increasing interest worldwide in the diagnosis of different types of colitis and colonoscopic biopsies play an important role in diagnosis and follow up of patients with colitis. But the interpretation of colonoscopic biopsies is sometimes a difficult task due to overlap between features of different types of colitis.
Therefore, we reviewed non-neoplastic colorectal biopsies received in our department in a period of six years in order to classify different types of colitis trying to make a clinically relevant rather than descriptive diagnoses through assessment of the colorectal mucosa using the guidelines published by the British Society of Gastroenterology, 1997 and in the view of other recent studies. Also we tried to provide recommendations for minimum clinical, endoscopic information, and precautions that should be followed in obtaining biopsy specimens for optimal pathological interpretation.
This is helpful to overcome the limited knowledge of both pathologists and clinicians regarding rare and recently introduced types of colitis.
In this retrospective study we evaluated 197 non-neoplastic colonoscopic biopsies, which were received at the department in a period of six years.
After examination, biopsies formed of single fragment, below 2 mm in diameter, without muscularis mucosa, and badly oriented, were unsatisfactory for pathological examination and excluded. These biopsies were 10 biopsies (5%).
The remaining 187 biopsies were categorized into normal or non-specific change or inflammation unclassified (67.9%), UC (10.7%), indeterminate colitis (1.6%), CD (2.1%), Bilharzial colitis (2.7%), Bilharzial polyp (2.1%), lymphocytic colitis (1.1%), eosinophilic colitis (1.6%), granulomatous colitis (2.1%), juvenile polyp (3.7%), hyperplastic polyp (4.3%).
After reviewing the slides, the reviewer diagnosis was different from the original diagnosis in (22%) of biopsies due to the introduction of new entities, and this discrepancy was highest in rare and recently described forms of colitis ( such as lymphocytic colitis).
We also evaluated the impact of biopsy satisfaction on reaching a specific diagnosis in colonoscopic biopsies, and we found that multiple biopsies, biopsies above 2 mm in diameter, those containing muscularis mucosa, and good orientation improve the diagnostic value of colonoscopic biopsies.