Preoperative computed tomography is poor in detecting tumors of the appendix among patients with acute appendicitis: A cohort study of 5,224 appendectomies

Abstract

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. LEVEL OF EVIDENCE Diagnostic, level IV.

Impact of the COVID-19 pandemic on appendicitis treatment in Germany—a population-based analysis

“…Hospital stay tends to be longer in the antibiotic therapy group, and approximately 30% of patients treated with antibiotics were in need of appendectomy within 1 year [3,18,19]. Another important aspect to consider are appendiceal malignancies that are coincidentally found in 0.7-2.5% of histopathological evaluation of appendectomy specimens [22][23][24]. Treating patients with antibiotics can delay the diagnosis and lead to incurable cancer stages.…”

Presentation and outcomes of acute appendicitis during COVID-19 pandemic: lessons learned from the Middle East—a multicentre prospective cohort study

“…Another important aspect to consider is appendiceal malignancies that account for up to 2.5% of the appendectomy specimens. There is a concern that antibiotic-only treatment may cause a delay in the diagnosis and management of incidental malignancies [35,36]. Uncomplicated AA should be treated conservatively during the COVID-19 pandemic, when possible, as per the recommendation of a recent meta-analysis.…”

Double-Expressor Appendiceal Burkitt’s Lymphoma: A Case Report and Literature Review

“…Although preoperative CT scans can be used in confirming the presence of appendicitis with high sensitivity [6], they are not great at identifying if the cause is neoplastic [10]. A cohort study was published in 2020 which concluded that even if CT scans cannot identify neoplastic causes, they cannot exclude them either [10].…”

“…Although preoperative CT scans can be used in confirming the presence of appendicitis with high sensitivity [6], they are not great at identifying if the cause is neoplastic [10]. A cohort study was published in 2020 which concluded that even if CT scans cannot identify neoplastic causes, they cannot exclude them either [10]. On the other hand, if the tumor has lymph node involvement, distant metastasis, or features that suggest an underlying malignancy, a preoperative CT scan could give us some hints on the underlying etiology [11].…”