阑尾 CT 检查发现的阑尾钙化对阑尾上皮性肿瘤的预测价值。
Utility of Appendiceal Calcifications Detected on Computed Tomography as a Predictor for an Underlying Appendiceal Epithelial Neoplasm.
机构信息
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Wayne State University, Karmanos Cancer Institute, Detroit, MI, USA.
出版信息
Ann Surg Oncol. 2017 Nov;24(12):3667-3672. doi: 10.1245/s10434-017-6052-7. Epub 2017 Aug 22.
BACKGROUND
Mucinous appendiceal neoplasms can contain radiopaque calcifications. Whether appendiceal radiographic calcifications indicate the presence of an appendiceal epithelial neoplasm is unknown. This study aimed to determine whether appendiceal calcifications detected by computed tomography (CT) correlate with the presence of appendiceal epithelial neoplasms.
METHODS
From prospective appendiceal and pathology databases, 332 cases of appendiceal neoplasm and 136 cases of control appendectomy were identified, respectively. Only cases with preoperative CT scans available for review were included in the study. Images were reviewed by two abdominal radiologists. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated, and the kappa statistic was used to determine agreement between the radiologists' interpretations.
RESULTS
Interobserver agreement between the radiologists was substantial, with a kappa of 0.74. Appendiceal mural calcifications were identified on CT scans in 106 appendiceal neoplasm cases (32%) and in 1 control case (1%) (P = 0.0001). In the appendiceal neoplasm subgroup, the presence of radiographic calcifications was associated with mucinous histology (35% vs 17%; P = 0.006; odds ratio [OR], 0.38; 95% confidence interval [CI], 0.18-0.78) and with well-differentiated histologic grade (40% vs 24%; P = 0.002; OR, 0.47; 95% CI, 0.29-0.76). The findings showed a sensitivity of 31.9% (95% CI, 26.9-37.2%), a specificity of 99.3% (95% CI, 96-100%), a PPV of 99.1% (95% CI, 94.9-100%), and an NPV of 37.4% (95% CI, 32.4-42.6%).
CONCLUSION
This case-control study showed that appendiceal mural calcifications detected on CT are associated with underlying appendiceal epithelial neoplasms and that the identification of incidental mural appendiceal calcifications may have an impact on decisions regarding surgical intervention.
背景
黏液性阑尾肿瘤可含有放射状钙化。阑尾放射状钙化是否提示存在阑尾上皮性肿瘤尚不清楚。本研究旨在确定 CT 检测到的阑尾钙化是否与阑尾上皮性肿瘤的存在相关。
方法
从前瞻性阑尾和病理数据库中，分别确定了 332 例阑尾肿瘤和 136 例对照性阑尾切除术的病例。仅纳入有术前 CT 扫描可供回顾的病例。由两名腹部放射科医生对图像进行评估。计算了敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV），并使用κ统计量来确定两位放射科医生的解释之间的一致性。
结果
两位放射科医生之间的观察者间一致性较好，κ值为 0.74。CT 扫描在 106 例阑尾肿瘤病例（32%）和 1 例对照病例（1%）中发现阑尾壁钙化（P=0.0001）。在阑尾肿瘤亚组中，存在放射状钙化与黏液组织学相关（35%比 17%；P=0.006；比值比[OR]，0.38；95%置信区间[CI]，0.18-0.78）和分化良好的组织学分级相关（40%比 24%；P=0.002；OR，0.47；95%CI，0.29-0.76）。结果显示，敏感性为 31.9%（95%CI，26.9-37.2%），特异性为 99.3%（95%CI，96-100%），PPV 为 99.1%（95%CI，94.9-100%），NPV 为 37.4%（95%CI，32.4-42.6%）。
结论
本病例对照研究表明，CT 检测到的阑尾壁钙化与潜在的阑尾上皮性肿瘤相关，偶然发现的阑尾壁钙化可能会影响手术干预的决策。
Zotero 插件