Preoperative computed tomography is poor in detecting tumors of the appendix among patients with acute appendicitis: A cohort study of 5,224 appendectomies
Preoperative computed tomography is poor in detecting tumors of the appendix among patients with acute appendicitis: A cohort study of 5,224 appendectomies
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DOI：
10.1097/ta.0000000000002567
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发表时间：
2020-03-01
影响因子：
3.4
通讯作者：
Ukkonen, Mika
中科院分区：
文献类型：
--
作者：
Kangaspunta, Helmi;Tahkola, Kyosti;Ukkonen, Mika
背景：肿瘤过程是急性阑尾炎的已知病因之一。虽然单独使用抗生素保守治疗已被提议作为无并发症阑尾炎的治疗方法，但在为患者提供这种选择时应排除肿瘤的存在。本研究的目的是评估计算机断层扫描（CT）检测阑尾肿瘤的准确性。方法：纳入2007年1月至2018年10月3日期间在我校医院连续接受急性阑尾炎手术的患者。每当阑尾肿瘤得到组织病理学证实时，都会仔细审查 CT 解释和手术报告。所有 CT 扫描均由顾问身体放射科医生重新分析。初步和最终放射学解释之间存在差异。结果：共有 5,224 名患者接受了阑尾切除术，其中 4,766 名经组织病理学证实患有急性阑尾炎。 84 名患者（中位年龄 61 (13-89) 岁；54% 女性）被诊断患有阑尾肿瘤。 52 名患者 (62%) 患有无并发症的阑尾炎。尽管肿瘤的发病率与年龄有关，但所有年龄段的人都发现了肿瘤。研究期间，肿瘤的比例从每年 1.7% 增加到 3.0%。最常见的肿瘤是神经内分泌肿瘤（n = 33）、低度阑尾粘液性肿瘤（n = 14）和腺癌（n = 11）。 61 名患者 (73%) 接受了术前 CT 检查。在值班时间内，计算机断层扫描解释仅 1 例（3.4%）浸润性肿瘤和 5 例（16%）非浸润性肿瘤疑似肿瘤。结论：阑尾标本中可能发现阑尾肿瘤，大多数患者患有无并发症的急性阑尾炎。根据这些发现，我们得出结论，CT 不能用于排除急性阑尾炎的肿瘤病因。 （版权所有 (c) 2019 Wolters Kluwer Health, Inc. 保留所有权利。）证据级别：诊断，IV 级。
BACKGROUND: Neoplastic processes are among the known etiologies for acute appendicitis. While conservative treatment with antibiotics alone has been proposed as a treatment for uncomplicated appendicitis, the presence of tumors should be excluded when offering patients this option. The aim of this study was to assess the accuracy of computed tomography (CT) in detecting appendiceal tumors.METHOD: Consecutive patients operated on for acute appendicitis between January 2007 and October 3, 2018, in our university hospital were included. Whenever appendiceal tumor was histopathologically confirmed, CT interpretations and surgical reports were carefully reviewed. All CT scans were reanalyzed by consultant body radiologists. Discrepancies between the preliminary and final radiological interpretations were noted.RESULTS: A total of 5,224 patients underwent appendectomy, of whom 4,766 had histopathologically confirmed acute appendicitis. Eighty-four patients (median, 61 (13-89) years; 54% female) were diagnosed with appendiceal tumor. Fifty-two patients (62%) had uncomplicated appendicitis. Although incidence of tumors was associated with older age, tumors were found in all ages. The share of tumors increased from 1.7% to 3.0%/year during the study. The most common tumors were neuroendocrine tumors (n = 33), low-grade appendiceal mucinous neoplasms (n = 14), and adenocarcinomas (n = 11). Sixty-one patients (73%) underwent preoperative CT. Computed tomography interpretation during on-call hours suspected tumor in only one case (3.4%) with invasive tumor, and in five cases (16%) with noninvasive tumor.CONCLUSION: Appendiceal tumors are possible findings in appendix specimens, and most patients had uncomplicated acute appendicitis. In light of findings we conclude that CT cannot be used to exclude neoplastic etiology underlying acute appendicitis. (Copyright (c) 2019 Wolters Kluwer Health, Inc. All rights reserved.)LEVEL OF EVIDENCE: Diagnostic, level IV.