The clinical significance of Crohn disease activity at resection margins

Sasan Setoodeh, Li Liu, Sarag A. Boukhar, Amit Singal, Maria Westerhoff, Akbar K. Waljee, Tasneem F Ahmed, Purva Gopal

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Abstract

Context.-Conflicting data about the clinical significance of microscopic Crohn disease (CD) activity at resection margins have led to varying practice patterns for routine reporting by pathologists. Objective.-To characterize the association between active disease at resection margins with postoperative CD recurrence and time-to-recurrence in the era of anti-tumor necrosis factor therapy. Design.-We performed a multicenter retrospective cohort study of 101 consecutive CD bowel resections during 10 years. Margin slides were reviewed, and CD activity at the margins was graded as none, mild, moderate, or severe. The association between microscopic CD activity at the margin with postoperative recurrence and time-to-recurrence were evaluated with logistic regression and Cox regression analyses, respectively. Results.-Crohn disease activity at resection margins was reported in 43% of pathology reports. Resection margins had CD involvement in 39.6% of cases, 20 of which were classified as mild, 6 as moderate, and 12 with severe CD activity. Although patients with mild (odds ratio, 1.14; 95% CI, 0.40-3.20) and moderate to severe (odds ratio, 1.97; 95% CI, 0.62-6.35) activity were at increased risk of disease recurrence, the differences were not statistically significant. Patients with mild (hazard ratio, 0.97; 95% CI, 0.50-1.91) and moderate to severe (hazard ratio, 1.29; 95% CI, 0.65-2.55) disease activity at margins did not have significantly different time-to-recurrence compared with those without disease activity. Conclusions.-Our study suggests CD activity at resection margins is not significantly associated with postoperative CD recurrence.

Original languageEnglish (US)
Pages (from-to)505-509
Number of pages5
JournalArchives of Pathology and Laboratory Medicine
Volume143
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Crohn Disease
Recurrence
Odds Ratio
Margins of Excision
Cohort Studies
Retrospective Studies
Tumor Necrosis Factor-alpha
Logistic Models
Regression Analysis
Pathology

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

Cite this

The clinical significance of Crohn disease activity at resection margins. / Setoodeh, Sasan; Liu, Li; Boukhar, Sarag A.; Singal, Amit; Westerhoff, Maria; Waljee, Akbar K.; Ahmed, Tasneem F; Gopal, Purva.

In: Archives of Pathology and Laboratory Medicine, Vol. 143, No. 4, 01.04.2019, p. 505-509.

Research output: Contribution to journalArticle

Setoodeh, Sasan ; Liu, Li ; Boukhar, Sarag A. ; Singal, Amit ; Westerhoff, Maria ; Waljee, Akbar K. ; Ahmed, Tasneem F ; Gopal, Purva. / The clinical significance of Crohn disease activity at resection margins. In: Archives of Pathology and Laboratory Medicine. 2019 ; Vol. 143, No. 4. pp. 505-509.
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abstract = "Context.-Conflicting data about the clinical significance of microscopic Crohn disease (CD) activity at resection margins have led to varying practice patterns for routine reporting by pathologists. Objective.-To characterize the association between active disease at resection margins with postoperative CD recurrence and time-to-recurrence in the era of anti-tumor necrosis factor therapy. Design.-We performed a multicenter retrospective cohort study of 101 consecutive CD bowel resections during 10 years. Margin slides were reviewed, and CD activity at the margins was graded as none, mild, moderate, or severe. The association between microscopic CD activity at the margin with postoperative recurrence and time-to-recurrence were evaluated with logistic regression and Cox regression analyses, respectively. Results.-Crohn disease activity at resection margins was reported in 43{\%} of pathology reports. Resection margins had CD involvement in 39.6{\%} of cases, 20 of which were classified as mild, 6 as moderate, and 12 with severe CD activity. Although patients with mild (odds ratio, 1.14; 95{\%} CI, 0.40-3.20) and moderate to severe (odds ratio, 1.97; 95{\%} CI, 0.62-6.35) activity were at increased risk of disease recurrence, the differences were not statistically significant. Patients with mild (hazard ratio, 0.97; 95{\%} CI, 0.50-1.91) and moderate to severe (hazard ratio, 1.29; 95{\%} CI, 0.65-2.55) disease activity at margins did not have significantly different time-to-recurrence compared with those without disease activity. Conclusions.-Our study suggests CD activity at resection margins is not significantly associated with postoperative CD recurrence.",
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N2 - Context.-Conflicting data about the clinical significance of microscopic Crohn disease (CD) activity at resection margins have led to varying practice patterns for routine reporting by pathologists. Objective.-To characterize the association between active disease at resection margins with postoperative CD recurrence and time-to-recurrence in the era of anti-tumor necrosis factor therapy. Design.-We performed a multicenter retrospective cohort study of 101 consecutive CD bowel resections during 10 years. Margin slides were reviewed, and CD activity at the margins was graded as none, mild, moderate, or severe. The association between microscopic CD activity at the margin with postoperative recurrence and time-to-recurrence were evaluated with logistic regression and Cox regression analyses, respectively. Results.-Crohn disease activity at resection margins was reported in 43% of pathology reports. Resection margins had CD involvement in 39.6% of cases, 20 of which were classified as mild, 6 as moderate, and 12 with severe CD activity. Although patients with mild (odds ratio, 1.14; 95% CI, 0.40-3.20) and moderate to severe (odds ratio, 1.97; 95% CI, 0.62-6.35) activity were at increased risk of disease recurrence, the differences were not statistically significant. Patients with mild (hazard ratio, 0.97; 95% CI, 0.50-1.91) and moderate to severe (hazard ratio, 1.29; 95% CI, 0.65-2.55) disease activity at margins did not have significantly different time-to-recurrence compared with those without disease activity. Conclusions.-Our study suggests CD activity at resection margins is not significantly associated with postoperative CD recurrence.

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