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Retrospective case-control study to predict a potential underlying appendiceal tumor in an acute appendicitis context based on a CT-scoring system.

Authors
  • Monsonis, B1
  • Zins, M2
  • Orliac, C1
  • Mandoul, C3
  • Boulay-Coletta, I2
  • Curros-Doyon, F1
  • Molinari, N4
  • Taourel, P3
  • Millet, I5
  • 1 Department of Medical Imaging, Lapeyronie University Hospital, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier, France. , (France)
  • 2 Department of Medical Imaging, Saint Joseph's Hospital, 185 rue Raymond Losserand, 75014, Paris, France. , (France)
  • 3 Department of Medical Imaging, Lapeyronie University Hospital, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier, France; University of Montpellier, France. , (France)
  • 4 Department of Statistics, Montpellier University Hospital, 39 Avenue Charles Flahault, 34090, Montpellier, France; University of Montpellier, France. , (France)
  • 5 Department of Medical Imaging, Lapeyronie University Hospital, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier, France; University of Montpellier, France. Electronic address: [email protected] , (France)
Type
Published Article
Journal
European journal of radiology
Publication Date
Jan 08, 2021
Volume
136
Pages
109525–109525
Identifiers
DOI: 10.1016/j.ejrad.2021.109525
PMID: 33454458
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To assess CT signs to discriminate an appendiceal tumor versus a non-tumoral appendix in an acute appendicitis context. A 10-year bicentric retrospective case-control study was performed in adults. Patients with a histopathological appendiceal tumor and appendicitis were paired for age and sex with patients with non-tumorous appendicitis (1/3 ratio, respectively). Two senior radiologists blindly analyzed numerous CT findings with final consensus to perform univariate and multivariate statistical analyses. A diagnostic CT scan score was calculated with a bootstrap internal validation. Reproducibility was assessed based on the kappa statistic. A total of 208 patients (51 +/- 21 years; 114 males) were included (52 patients in the tumor group and 156 in the non-tumor group). In the multivariate analysis, an appendicolith and fat stranding were protective factors with OR = 0.2 (p = 0.01) and OR = 0.3 (p = 0.02), respectively, while mural calcifications (OR = 47, p = 0.0001), an appendix mass (OR = 7.1, p = 0.008), a focal asymmetric wall abnormality (OR = 4.9, p = 0, 001), or a ≥ 15 mm diameter (OR = 3.5, p = 0.009) were positive predictive factors of an underlying tumor. Using a ≥1 cut-off, our diagnostic score had an AUC = 0.87 (95 % CI, 0.82-0.93) and a positive likelihood ratio = 13.5 (95 % CI, 6.7-27.1). We developed a reliable scoring system based on CT findings, which is highly predictive of an underlying appendiceal neoplasm in an appendicitis context using a ≥1 cut-off. Copyright © 2021 Elsevier B.V. All rights reserved.

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