DIAGNOSTIC ACCURACY OF IMAGING VERSUS HISTOPATHOLOGY IN INTESTINAL TUBERCULOSIS

Abstract

Intestinal tuberculosis is a diagnostically challenging form of extrapulmonary tuberculosis because its clinical, endoscopic, radiologic, and histopathologic features overlap substantially with Crohn’s disease, intestinal malignancy, and other chronic inflammatory bowel disorders. Delayed diagnosis may lead to inappropriate therapy and increased morbidity. This study evaluated the diagnostic accuracy of imaging in comparison with histopathology in intestinal tuberculosis and assessed their complementary role in clinical diagnosis.

Methods: This study was conducted as a structured comparative literature analysis of published biomedical evidence on intestinal tuberculosis. Relevant studies addressing imaging, histopathology, colonoscopy-guided biopsy, and cross-sectional radiologic evaluation were reviewed. Diagnostic performance indicators including sensitivity, specificity, diagnostic yield, and major distinguishing features were extracted and synthesized.

Results: Histopathology showed high confirmatory value when classical findings such as caseating necrosis, confluent granulomas, epithelioid granulomas, or acid-fast bacilli positivity were identified, but its sensitivity was limited by superficial biopsy sampling and patchy lesion distribution. Imaging provided important complementary information by demonstrating bowel wall thickening, ileocecal disease, strictures, mesenteric inflammation, lymphadenopathy, and extraintestinal extension. Necrotic lymph nodes emerged as one of the most useful radiologic indicators favoring intestinal tuberculosis, whereas comb sign and skip lesions were more suggestive of Crohn’s disease. Imaging also showed value in follow-up evaluation and treatment-response assessment.

Conclusion: Histopathology is still the most specific confirmatory modality in intestinal tuberculosis, while imaging enhances diagnostic confidence by defining disease extent, identifying extraintestinal clues, and aiding differentiation from Crohn’s disease. The most consistent diagnostic approach is multimodal, involving imaging, histopathology, microbiological tests, and clinicoradiologic follow-up.