Diagnostic Accuracy of Ultrasound for Acute Appendicitis Compared with Histopathological Findings

Faraj A. Aljali; Fathi A. Abdalla Asnini

doi:10.64516/bzvhd360

Authors

Faraj A. Aljali Department of General Surgery, Faculty of Medicine, Tobruk University, Tobruk, Libya Author
Fathi A. Abdalla Asnini Department of General Surgery, Faculty of Medicine, Tobruk University, Tobruk, Libya Author

DOI:

https://doi.org/10.64516/bzvhd360

Keywords:

Acute appendicitis, Ultrasonography, Histopathology, Diagnostic accuracy

Abstract

Background: Acute appendicitis is one of the most common surgical emergencies worldwide. Ultrasound is widely used as a first-line imaging modality; however, histopathological examination remains the gold standard for confirming the diagnosis. Objective: To evaluate the diagnostic accuracy of ultrasound compared with histopathological findings in patients with suspected acute appendicitis. Methods: A diagnostic accuracy study was conducted on 125 patients with suspected acute appendicitis at Tobruk Medical Centre between January and December 2021. All patients underwent preoperative ultrasound examination followed by appendectomy and postoperative histopathological evaluation. Data were analysed using the Chi-square test, and a p-value <0.05 was considered statistically significant. Results: Among the 125 patients, histopathological examination confirmed acute appendicitis in 106 cases (84.8%). Ultrasound demonstrated a sensitivity of 95.1%, specificity of 66.7%, positive predictive value of 90.4%, and negative predictive value of 80.3%, with an overall diagnostic accuracy of 89.6%. Conclusion: Ultrasound is a highly sensitive and useful first-line imaging modality for the diagnosis of acute appendicitis; however, its moderate specificity limits its ability to definitively confirm the diagnosis. Ultrasound should therefore be interpreted alongside clinical assessment and other diagnostic findings.

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References

1. Stewart B, Khanduri P, McCord C, Ohene-Yeboah M, Uranues S, Rivera FV, Mock C. Global disease burden of conditions requiring emergency surgery. Br J Surg. 2014;101: e9–e22. DOI: https://doi.org/10.1002/bjs.9329

2. Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW, Bhala N, Ghosh S, Dixon E, Ng S, et al. The global incidence of appendicitis. Ann Surg. 2017; 266:237–241. DOI: https://doi.org/10.1097/SLA.0000000000002188

3. Oeppen J, Vaupel JW. Broken limits to life expectancy. Science. 2002; 296:1029–1031. DOI: https://doi.org/10.1126/science.1069675

4. Kraemer M, Franke C, Ohmann C, Yang Q; The Acute Abdominal Pain Study Group. Acute appendicitis in late adulthood: incidence, presentation, and outcome. Results of a prospective multicentre acute abdominal pain study and a review of the literature. Langenbecks Arch Surg. 2000; 385:470–481. DOI: https://doi.org/10.1007/s004230000165

5. Weinandt M, Godiris-Petit G, Menegaux F, Chereau N, Lupinacci RM. Appendicitis is a severe disease in elderly patients: a twenty-year audit. JSLS. 2020;24: e2020.00046. DOI: https://doi.org/10.4293/JSLS.2020.00046

6. McGowan D, Howlader M, Patel R, Swindlehurst N, Manifold D, Shaikh I. Management and outcome of appendicitis among octogenarians in an English hospital over a five-year period. Int J Surg. 2011; 9:669–671. DOI: https://doi.org/10.1016/j.ijsu.2011.10.004

7. Shchatsko A, Brown R, Reid T, Adams S, Alger A, Charles A. The utility of the Alvarado score in the diagnosis of acute appendicitis in the elderly. Am Surg. 2017; 83:793–798. DOI: https://doi.org/10.1177/000313481708300740

8. Hong YR, Chung CW, Kim JW, Kwon CI, Ahn DH, Kwon SW, Kim SK. Hyperbilirubinemia is a significant indicator for the severity of acute appendicitis. J Korean Soc Coloproctol. 2012; 28:247–252. DOI: https://doi.org/10.3393/jksc.2012.28.5.247

9. Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg. 2013; 97:299–304. DOI: https://doi.org/10.9738/CC161.1

10. Farooqui W, Pommergaard HC, Burcharth J, Eriksen JR. The diagnostic value of a panel of serological markers in acute appendicitis. Scand J Surg. 2015; 104:72–78. DOI: https://doi.org/10.1177/1457496914529273

11. Shin DH, Cho YS, Kim YS, Ahn HC, Oh YT, Park SO, Won MH, Cho JH, Kim YM, Seo JY, et al. Delta neutrophil index: a reliable marker to differentiate perforated appendicitis from non-perforated appendicitis in the elderly. J Clin Lab Anal. 2018;32: e22177. DOI: https://doi.org/10.1002/jcla.22177

12. Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, Dick PT. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology. 2006; 241:83–94. DOI: https://doi.org/10.1148/radiol.2411050913

13. Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiology. 1986; 158:355–360. DOI: https://doi.org/10.1148/radiology.158.2.2934762

14. Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology. 2000; 215:337–348. DOI: https://doi.org/10.1148/radiology.215.2.r00ma24337

15. Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015; 386:1278–1287. DOI: https://doi.org/10.1016/S0140-6736(15)00275-5

16. Rao PM, Rhea JT, Novelline RA, McCabe CJ, Lawrason JN. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998; 338:141–146. DOI: https://doi.org/10.1056/NEJM199801153380301

17. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986; 15:557–564. DOI: https://doi.org/10.1016/S0196-0644(86)80993-3