Department of General Surgery and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel.
Int J Surg. 2016 Oct;34:81-85. doi: 10.1016/j.ijsu.2016.08.021. Epub 2016 Aug 20.
Ultrasonography is frequently used to diagnose acute appendicitis in women of reproductive age, but its diagnostic value in pregnant patients remains unclear. This study sought to compare the diagnostic performance of ultrasound in pregnant and young nonpregnant women with suspected acute appendicitis.
The database of a single tertiary medical center was reviewed for all women of reproductive age who underwent appendectomy either during pregnancy (2000-2014) or in the nonpregnant state (2004-2007) following ultrasound evaluation. The performance of ultrasound in terms of predicting the final pathologic diagnosis was compared between the pregnant and non pregnant groups using receiver operating characteristic curve analysis.
Of 586 young women treated for appendicitis during the study periods (92 pregnant, 494 non-pregnant), 200 underwent preoperative ultrasound [67 pregnant, and 133 nonpregnant young women]. The pregnant and nonpregnant groups were comparable in age and presenting symptoms. There was no significant difference in the predictive performance of ultrasound between the two groups (AUC 0.76 and 0.73 respectively, p = 0.78) or within the pregnant group, by trimester [first (n = 23), AUC 0.73; second (n = 32), AUC 0.67; third (n = 12), AUC 0.86; p = 0.4]. Ultrasound had a positive predictive value of 0.94 in the pregnant group and 0.91 in the nonpregnant group; corresponding negative predictive values were 0.40 and 0.43.
There appears to be no difference in the ability of ultrasound to predict the diagnosis of acute appendicitis between pregnant women and nonpregnant women of reproductive age. Therefore, similar preoperative imaging algorithms may be used in both patient populations.
超声检查常用于诊断育龄期女性的急性阑尾炎，但在孕妇中的诊断价值尚不清楚。本研究旨在比较超声检查在疑似急性阑尾炎的孕妇和年轻非孕妇中的诊断性能。
回顾单一三级医疗中心的数据库，纳入所有在超声检查后接受阑尾切除术的育龄期女性（2000-2014 年妊娠期间，2004-2007 年非妊娠期间）。采用受试者工作特征曲线分析比较两组患者超声检查预测最终病理诊断的效能。
研究期间，共有 586 例年轻女性因阑尾炎接受治疗（孕妇 92 例，非孕妇 494 例），其中 200 例行术前超声检查[孕妇 67 例，非孕妇年轻女性 133 例]。孕妇和非孕妇组在年龄和临床表现方面无显著差异。两组之间的超声检查预测性能无显著差异（AUC 分别为 0.76 和 0.73，p=0.78），或在孕妇组内，根据妊娠时间分期[第一孕期（n=23，AUC 0.73）；第二孕期（n=32，AUC 0.67）；第三孕期（n=12，AUC 0.86），p=0.4]也无显著差异。在孕妇组中，超声检查的阳性预测值为 0.94，非孕妇组为 0.91；相应的阴性预测值分别为 0.40 和 0.43。
超声检查预测急性阑尾炎诊断的能力在孕妇和育龄期非孕妇之间似乎没有差异。因此，在这两种患者人群中可以使用类似的术前影像学算法。
