Obtaining five or more biopsy specimens from mild-to-moderate ulcerative lesions—particularly in the terminal ileum—can yield granuloma detection rates exceeding 70% in this granuloma-positive Crohn’s disease cohort, according to a recent study.
The retrospective analysis included 308 patients with at least one granuloma-positive biopsy obtained between January 2018 and May 2024. Data from 1,354 biopsy sites and 1,505 corresponding endoscopic images were reviewed. Histopathologic evaluation was performed by experienced gastrointestinal pathologists, and associations between detection rates and specimen size, specimen quantity, bowel segment, lesion severity, and lesion morphology were examined.
Granuloma detection rates were strongly associated with specimen size. Rates were 29% for specimens less than or equal to 0.1 cm in diameter compared with 42% for those measuring 0.1 to 0.2 cm and 42% for specimens greater than 0.2 cm. The number of biopsy specimens also affected detection, with rates increasing from 28% for a single specimen to 42% for three specimens and reaching 72% for five or more specimens.
By intestinal segment, detection was highest in the terminal ileum (50%), followed by the left colon (41%) and right colon (39%). The rectum had the lowest rate at 28%.
Lesion severity, graded using a modified Simple Endoscopic Score for Crohn’s Disease, also influenced outcomes. Mild-to-moderate lesions (score ≤ 3) yielded higher detection rates than severe lesions (37% vs 30%), while normal mucosa showed only 2%. This pattern was consistent in both ileal and colorectal subgroups.
Ulcerative lesions had higher detection than non-ulcerative lesions (42% vs 32%). Among ulcer subtypes, longitudinal ulcers had the highest rate (46%), followed by patchy (42%) and irregular (42%) ulcers. Detection rates among ulcer subtypes were comparable.
The researchers reported no conflicts of interest.