A colorectal mosaic pattern might be an endoscopic feature of collagenous colitis |
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| Authors: | Daniel G Cimmino José M Mella Lisandro Pereyra Pablo AE Luna Gabriel Casas Ignacio Caldo Federico Popoff Silvia Pedreira Luis A Boerr |
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| Institution: | 1. University Hospital of North Norway Harstad, Harstad, Norway;2. Sjøkanten Legesenter, Harstad, Norway;3. University Hospital of North Norway Tromsø, Tromsø, Norway;4. Norwegian Centre of Rural Medicine, UIT Arctic University of Norway, Tromsø, Norway;5. UIT The Arctic University of Norway, Tromsø, Norway;1. Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York;2. Department of Medicine, Weill Cornell Medical College, New York, New York;3. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York;4. Department of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, New York, New York;5. Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York;1. Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-based Functional Materials and Devices, Soochow University, Suzhou, Jiangsu 215123, China;2. State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu 215123, China;1. Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;3. Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;4. Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR 97213, USA;5. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA;6. Medical Oncology, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain;7. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;8. Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;9. Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98105, USA;10. Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;11. Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL 60637, USA;12. Department of Surgery and University of Virginia Cancer Center, University of Virginia School of Medicine, Charlottesville, VA 22908, USA;13. Bristol-Myers Squibb, Princeton, NJ 08648, USA;14. Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA |
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| Abstract: | Background and aimsThe endoscopic aspect of the colorectal mucosa in those patients with collagenous colitis is usually normal, or with non-specific changes. Until now it had never been related to a mucosal pattern of mosaic type. Our aim was to determine the diagnostic accuracy of the presence of mosaic pattern in the colorectal mucosa for collagenous colitis.MethodsPatients who had undergone a colonoscopy with random biopsies performed in the diagnostic evaluation of chronic diarrhea between 2004 and 2008 were studied. We defined patients with chronic diarrhea and mosaic mucosal pattern as “cases”, and patients with chronic diarrhea without mosaic pattern as “controls”. The odds ratio (OR) of finding a collagenous colitis in view of a mosaic pattern in colon was determined; as well as sensitivity and specificity; positive and negative likelihood ratios (LR+, LR?), considering this finding as a diagnostic instrument for collagenous colitis.Results252 patients who had undergone colonoscopý with biopsy due to chronic diarrhea were analyzed. In 6 patients, a mosaic pattern was identified in the colorectal mucosa. The histological diagnose of 36 of the 252 patients (14%) was microscopic colitis, 27 of which (11%) had collagenous colitis. The colonoscopy was found normal in 21 of these 27 patients; in 2 patients, congestion or petechiae was found in the rectum; and in 4 patients (15%), all women, a mosaic pattern was found in the rectosigmoid mucosa. The OR of this finding was 19.4 (CI95% 3.9–95.4) for collagenous colitis. It had a sensitivity of 14.8% (CI95% 6.8–20), a specificity of 99.1% (CI95% 98.2–99.7), LR+ of 16.6 (CI95% 3.7–76.4), and LR? of 0.86 (CI95% 0.80–0.95) for a collagenous colitis.ConclusionThe mosaic pattern in the colorectal mucosa of patients studied due to chronic diarrhea could be a distinguishing feature of collagenous colitis. |
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