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01-11-2017 | Gastrointestinal Oncology

Utility of Appendiceal Calcifications Detected on Computed Tomography as a Predictor for an Underlying Appendiceal Epithelial Neoplasm

Authors: Tara L. Sagebiel, MD, Amr Mohamed, MD, Aurelio Matamoros, MD, Melissa W. Taggart, MD, Fred Doamekpor, MD, Kanwal P. Raghav, MD, Gary N. Mann, MD, Paul F. Mansfield, MD, Cathy Eng, MD, Richard E. Royal, MD, Wai Chin Foo, MD, Joe E. Ensor, Keith F. Fournier, MD, Michael J. Overman, MD

Published in: Annals of Surgical Oncology | Issue 12/2017

Abstract

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.

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Title: Utility of Appendiceal Calcifications Detected on Computed Tomography as a Predictor for an Underlying Appendiceal Epithelial Neoplasm
Authors: Tara L. Sagebiel, MD
Amr Mohamed, MD
Aurelio Matamoros, MD
Melissa W. Taggart, MD
Fred Doamekpor, MD
Kanwal P. Raghav, MD
Gary N. Mann, MD
Paul F. Mansfield, MD
Cathy Eng, MD
Richard E. Royal, MD
Wai Chin Foo, MD
Joe E. Ensor
Keith F. Fournier, MD
Michael J. Overman, MD
Publication date: 01-11-2017
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 12/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-017-6052-7

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Utility of Appendiceal Calcifications Detected on Computed Tomography as a Predictor for an Underlying Appendiceal Epithelial Neoplasm

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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