Effective use of CT by surgeons in acute appendicitis diagnosis

BACKGROUND: Acute appendicitis (AA) still maintains its prominence among general surgical emergencies, and the risk of developing AA is 8.6% for men and 6.7% for women. The clinical diagnosis of acute appendicitis has a rate of approximately 20% false positive and false-negative. Ultrasound (US) and Computed Tomography (CT) are the imaging methods most utilized in this field. The present study aims to determine the relationship between the evaluation results of the clinician who examined the patient and the radiologist’s evaluation in the evaluation of cross-sectional imaging tests for the diagnosis of acute appendicitis.
METHODS: In this study, the records of 1891 patients who underwent an appendectomy in the General Surgery Clinic of Fatih Sultan Mehmet Training and Research Hospital between January 2010 and 2017 were reviewed retrospectively. From the file of the patients who underwent appendectomy with acute appendicitis and whose appendix was reported as normal in CT results, clinical examination findings of the patient in the emergency department and CT evaluation results of the relevant surgeon (Compatible with acute appendicitis, normal appendix or appendix could not be visualised) were recorded.
RESULTS: Of the 1891 patients, who underwent appendectomy on suspicion of acute appendicitis, 1478 had CT scans for diagnosis and 145 were reported as normal by radiologists. In the evaluations by surgeons of these CT results all reported as normal by radiologists, 105 (%) 72,4) were compatible with acute appendicitis, while 18 (12.4%) were considered normal. In 22 (15.2%) patients, appendix could not be the visualized by surgeons. 70.0% of the cases with Lymphoid hyperplasia - fibrous obliteration pathology result; 73.8% of the cases with acute appendicitis; 75.6% of those with phlegmonousappendicitis and 64.0% of those with gangrenous/perforated appendicitis were diagnosed as appendicitis by CT evaluation performed by a general surgeon.
CONCLUSION: Diagnostic accuracy rates increase significantly when the CT results are interpreted by the physician performing the clinical evaluation of the patient. The chance of reaching the correct diagnosis will increase with gaining the ability to interpret abdominal cross-sectional imaging techniques during general surgery specialty training.

Akut apandisit tanýsýnda cerrahýn BT’yi etkin kullanýmý

AMAÇ: Akut apandisit (AA), halen genel cerrahi acilleri arasýndaki önemini korumaktadýr ve bir insanýn hayatýnda AA geliþme riski, erkeklerde %8.6 ve kadýnlarda %6.7’dir. AA’nýn klinik tanýsý yaklaþýk %20 yanlýþ pozitif ve yanlýþ negatiflik oranýna sahiptir. Görüntüleme yöntemlerinden de bu alanda en çok ultrason (US) ve bilgisayarlý tomografiden (BT) faydalanýlmýþtýr. Bu çalýþmanýn amacý AA tanýsý amacýyla çekilen kesitsel görüntüleme incelemelerinin deðerlendirmesinde hastayý muayene eden klinisyenin deðerlendirme sonuçlarý ile radyoloji uzman deðerlendirmesi arasýndaki iliþkiyi saptamaktýr.
GEREÇ VE YÖNTEM: Bu çalýþmada Ocak 2010 ile 2017 tarihleri arasýnda, Fatih Sultan Mehmet Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði’nde apendektomi yapýlan 1891 hastanýn dosyasý geriye dönük olarak incelendi. AA kliniði ile apendektomi yapýlan ve BT sonuçlarýnda apendiks normal olarak rapor edilen hastalarýn dosyasýndan, hastanýn acil servise baþvurusundaki klinik muayene bulgularý ile birlikte ilgili cerrahýn BT deðerlendirme sonuçlarý (AA ile uyumlu, normal apendiks veya apendiks görüntülenmedi) kayýt edildi.
BULGULAR: Akut apandisit þüphesiyle apendektomi yapýlan 1891 hastanýn 1478’ine taný amacýyla BT çekildi ve 145’i radyoloji uzmanlarý tarafýndan normal olarak rapor edildi. Radyoloji uzmanlarý tarafýndan tamamý normal olarak rapor edilen bu BT sonuçlarýnýn cerrahlar tarafýndan yapýlan deðerlendirmesinde 105’i (%72.4) AA ile uyumlu bulunurken, 18’i (%12.4) normal olarak deðerlendirildi. Yirmi iki (%15.2) hastada cerrahlar tarafýndan apendiks vizüalize edilemedi. Patoloji sonucu lenfoid hiperplazi - fibröz obliterasyon gelen olgularýn %70.0’i; AA sonucu gelenlerin %73.8’i; Flegmenöz apandisit sonucu gelenlerin %75.6’sý ve gangranöz/perfore apandisit sonucu gelenlerin ise %64.0’ü genel cerrah tarafýndan yapýlan BT deðerlendirmesinde apandisit tanýsý almýþtýr.
TARTIÞMA: Hastanýn klinik deðerlendirmesini yapan cerrah tarafýndan yorumlanan BT sonucunda tanýsal doðruluk oranlarý belirgin bir þekilde artmaktadýr. Genel cerrahi uzmanlýk eðitimi sýrasýnda abdominal kesitsel görüntüleme tekniklerini yorumlayabilme yetisi kazanýlmasýyla birlikte doðru tanýya ulaþma þansý artacaktýr.