Exploration Of The Differential Diagnosis Model Of Crohn’s Disease And Primary Intestinal Lymphoma

BackgroundCrohn’s disease(CD)and Primary intestinal lymphoma(PIL)are very similar in clinical manifestations,and their endoscopic and imaging findings often overlap.So that their clinical misdiagnosis often occurs.The current clinical gold standard for correct identification between them is histopathological biopsy.However,since PIL mostly originates from the submucosa of the intestinal tract,colonoscopy biopsy is less sensitive,often with false negatives,and the preoperative diagnosis rate is low.Surgery is not the main treatment of the two,and the treatment between them is completely different.Consequently,there is an urgent need for a new method or means to effectively identify the two before surgery.ObjectiveThe purpose of this study was to explore the clinical manifestations,endoscopic and CTE angiographic features of CD and PIL through retrospective clinical cases,and to explore a differential diagnosis potential model between CD and PIL.The aim is to improve the accuracy of the differential diagnosis of CD and PIL,to avoid misdiagnosis as much as possible,and to help clinical decisions.MethodThe study retrospectively analyzed the medical records of 74 patients with CD and 44 patients with PIL.Collect their epidemiological,clinical manifestations,laboratory tests,colonoscopy(including enteroscopy)features and CT enterography(CTE)parameters.Univariate and multivariate analysis were performed for each parameter,and the points that can significantly distinguish the two are screened to establish mathematical regression equations and draw a nomogram.The model discrimination was tested by ROC curve and NRI.We use Hosmer-Lemeshow test and calibration plot to evaluate the consistency of the model.ResultUnivariate analysis showed that at the age of 45 years,body mass index(BMI)> 19.5,diarrhea,mucus stool,elevated platelet count,elevated lactate dehydrogenase,and elevated D-dimer were the main points for the differentiation of CD and PIL.There were statistically significant differences between anal canal ulcer,longitudinal ulcer,"pebbles" sign,ileocecal valve involvement,intestinal mass,endoscopic scar,and intestinal stiffness during endoscopic examination.During CTE examination,abdominal mass,intestinal stenosis,aneurysm-like dilatation,"hamburger" sign,extraintestinal mass> 0.5cm,ΔCT> 40,intestinal wall thickness> 1.36 cm,"target" sign,comb sign,The number of affected intestinal segments ≥ 3,contralateral mesenteric diverticulum,fistula formation,and retroperitoneal lymphadenopathy were significantly different in CD and PIL.According to the univariate analysis results,the above 32 indicators were integrated,and the multi-factor logistic retrospective analysis was used to establish a differential diagnosis model.They have higher sensitivity,specificity,accuracy,positive predictive value and negative predictive value.After testing,the new model established in this study has high discrimination and consistency.ConclusionPIL and CD are often misdiagnosed clinically.In this study,univariate and multivariate regression analysis was performed on clinical manifestations,laboratory indicators,endoscopy,and CTE signs.Logistic mathematical regression models were successfully used to explore and establish a simple differential diagnosis model.The model established by this research has higher diagnostic effectiveness.However,because the data of this study are from a single center,and PIL is a relatively rare clinical disease,the sample size is small and it is difficult to rule out the existence of research bias.This model has not been further validated.Multi-center,prospective cases will be included in the future,and the sample size will be increased to further validate and improve the model.