术前计算机断层扫描在急性阑尾炎患者阑尾肿瘤的检测中效果不佳：一项 5224 例阑尾切除术的队列研究。

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

机构信息

From the Faculty of Medicine and Health Technology (H.K., J.L., M.U.), and Department of Gastroenterology and Alimentary Tract Surgery (K.T., E.-V.W., S.K., J.L., M.U.), Tampere University Hospital, Tampere, Finland.

出版信息

J Trauma Acute Care Surg. 2020 Mar;88(3):396-401. doi: 10.1097/TA.0000000000002567.

DOI:10.1097/TA.0000000000002567

PMID:32107355

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.

摘要

背景

肿瘤是引起急性阑尾炎的已知病因之一。虽然有人提出单独使用抗生素进行保守治疗是治疗单纯性阑尾炎的一种方法，但在为患者提供这种选择时，应排除肿瘤的存在。本研究旨在评估计算机断层扫描（CT）在检测阑尾肿瘤方面的准确性。

方法

连续纳入 2007 年 1 月至 2018 年 10 月 3 日期间在我们大学医院接受急性阑尾炎手术的患者。只要病理证实阑尾有肿瘤，就仔细审查 CT 解读和手术报告。所有 CT 扫描均由顾问级放射科医生重新分析。记录初步和最终放射学解读之间的差异。

结果

共有 5224 例患者接受了阑尾切除术，其中 4766 例病理证实为急性阑尾炎。84 例（中位数 61 岁[13-89 岁]；54%为女性）被诊断为阑尾肿瘤。52 例（62%）为单纯性阑尾炎。尽管肿瘤的发病率与年龄有关，但在所有年龄段都发现了肿瘤。在研究期间，肿瘤的发病率从 1.7%增加到 3.0%/年。最常见的肿瘤是神经内分泌肿瘤（n=33）、低级别阑尾黏液性肿瘤（n=14）和腺癌（n=11）。61 例（73%）患者在术前进行了 CT 检查。在值班期间，CT 解读仅在 1 例侵袭性肿瘤（3.4%）和 5 例非侵袭性肿瘤（16%）中怀疑肿瘤。