Annals of Coloproctology

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Unexpected Appendiceal Pathologies and Their Changes With the Expanding Use of Preoperative Imaging Studies: Hong Yeol Yoo, Jaewoo Choi, Jongjin Kim, Young Jun Chai, Rumi Shin, Hye Seong Ahn, Chang-Sup Lim, Hae Won Lee, Ki-Tae Hwang, In Mok Jung, Jung Kee Chung, Seung Chul Heo; Ann Coloproctol. 2017;33(3):99-105. Published online June 30, 2017; DOI: https://doi.org/10.3393/ac.2017.33.3.99

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Purpose

The preoperative diagnosis of acute appendicitis is often challenging. Sometimes, pathologic results of the appendix embarrass or confuse surgeons. Therefore, more and more imaging studies are being performed to increase the accuracy of appendicitis diagnoses preoperatively. However, data on the effect of this increase in preoperative imaging studies on diagnostic accuracy are limited. We performed this study to explore unexpected appendiceal pathologies and to delineate the role of preoperative imaging studies in the diagnosis of acute appendicitis.

Methods

The medical records of 4,673 patients who underwent an appendectomy for assumed appendicitis between 1997 and 2012 were reviewed retrospectively. Pathological results and preoperative imaging studies were surveyed, and the frequencies of pathological results and preoperative imaging studies were investigated.

Results

The overall rate of pathology compatible with acute appendicitis was 84.4%. Unexpected pathological findings, such as normal histology, specific inflammations other than acute appendicitis, neoplastic lesions, and other pathologies, comprised 9.6%, 3.3%, 1.2%, and 1.5%, respectively. The rate of unexpected pathological results was significantly reduced because of the increase in preoperative imaging studies. The decrease in normal appendices contributed the most to the reduction while other unexpected pathologies did not change significantly despite the increased use of imaging studies. This decrease in normal appendices was significant in both male and female patients under the age of 60 years, but the differences in females were more prominent.

Conclusion

Unexpected appendiceal pathologies comprised 15.6% of the cases. Preoperative imaging studies reduced them by decreasing the negative appendectomy rate of patients with normal appendices.

Citations

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Changing trends in appendiceal pathology: a 16-year retrospective extension study of surgically removed appendices in a tropical teaching hospital
Nicholas Awodele Awolola, Andrea Oludolapo Akinjo, AbdulRazzaq Oluwagbemiga Lawal, Kabir Bolarinwa Badmos, Fatimah Biade Abdulkareem
BMC Gastroenterology.2025;[Epub] CrossRef
The appendix: An unexpected band obstruction
Rowan Klein Nulend, Rakesh Quinn, Kar Yin Fok, Nimalan Pathmanathan
Journal of Case Reports and Images in Surgery.2024; 10(1): 1. CrossRef
The Vermiform Appendix and Its Pathologies
Marian Constantin, Livia Petrescu, Cristina Mătanie, Corneliu Ovidiu Vrancianu, Adelina-Gabriela Niculescu, Octavian Andronic, Alexandra Bolocan
Cancers.2023; 15(15): 3872. CrossRef
Rising incidence of appendiceal neoplasms over time: Does pathological handling of appendectomy specimens play a role?
Hisham F. Bahmad, Abed Alhalim Aljamal, Juan Carlos Alvarez Moreno, Ali Salami, Philip Bao, Sarah Alghamdi, Robert J. Poppiti
Annals of Diagnostic Pathology.2021; 52: 151724. CrossRef
The Impact of Pathological Criteria on Pediatric Negative Appendectomy Rate
Caroline Maloney, Morris C. Edelman, Alexandra C. Bolognese, Aaron M. Lipskar, Barrie S. Rich
Journal of Pediatric Surgery.2019; 54(9): 1794. CrossRef
Communication and management of incidental pathology in 1,214 consecutive appendicectomies; a cohort study
Ned Kinnear, Bridget Heijkoop, Eliza Bramwell, Alannah Frazzetto, Amy Noll, Prajay Patel, Derek Hennessey, Greg Otto, Christopher Dobbins, Tarik Sammour, James Moore
International Journal of Surgery.2019; 72: 185. CrossRef
Unexpected Appendiceal Pathologies and Preoperative Imaging Studies on Patients With Acute Appendicitis
Byung Chun Kim
Annals of Coloproctology.2017; 33(3): 82. CrossRef

Does T3 Subdivision Correlate with Nodal or Distant Metastasis in Colorectal Cancer?: Hong Yeol Yoo, Rumi Shin, Heon-Kyun Ha, Heung-Kwon Oh, Seung-Yong Jeong, Kyu Joo Park, Gyeong Hoon Kang, Woo Ho Kim, Jae-Gahb Park; J Korean Soc Coloproctol. 2012;28(3):160-164. Published online June 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.3.160

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10 Citations

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Purpose

We analyzed the clinical data of T3 colorectal cancer patients to assess whether T3 subdivision correlates with node (N) or metastasis (M) staging and stage-independent factors.

Methods

Five hundred fifty-five patients who underwent surgery for primary colorectal cancer from January 2003 to December 2009 were analyzed for T3 subdivision. T3 subdivision was determined by the depth of invasion beyond the outer border of the proper muscle (T3a, <1 mm; T3b, 1 to 5 mm; T3c, >5 to 15 mm; T3d, >15 mm). We investigated the correlation between T3 subdivision and N, M staging and stage-independent prognostic factors including angiolymphatic invasion (ALI), venous invasion (VI) and perineural invasion (PNI).

Results

The tumors of the 555 patients were subclassified as T3a in 86 patients (15.5%), T3b in 209 patients (37.7%), T3c in 210 patients (37.8%) and T3d in 50 patients (9.0%). The nodal metastasis rates were 39.5% for T3a, 56.5% for T3b, 75.7% for T3c and 74.0% for T3d. The distant metastasis rates were 7.0% for T3a 9.1% for T3b, 27.1% for T3c and 40.0% for T3d. Both N and M staging correlated with T3 subdivision (Spearman's rho = 0.288, 0.276, respectively; P < 0.001). Other stage-independent prognostic factors correlated well with T3 subdivision (Spearman's rho = 0.250, P < 0.001 for ALI; rho = 0.146, P < 0.001 for VI; rho = 0.271, P < 0.001 for PNI).

Conclusion

Subdivision of T3 colorectal cancer correlates with nodal and metastasis staging. Moreover, it correlates with other prognostic factors for colorectal cancer.

Citations

Citations to this article as recorded by

Facteurs pronostiques : degré d’invasion de la sous-séreuse, distance tumeur-séreuse et invasion de la limitante élastique de la sous-séreuse dans l’adénocarcinome colique
Arnaud Ronfaut, Christophe Attencourt, Jean-Rene Tesson, Charles Sabbagh, Jean-Marc Regimbeau, Denis Chatelain
Annales de Pathologie.2025; 45(2): 176. CrossRef
Do treated rectal tumors appear differently on MRI after chemotherapy versus chemoradiotherapy?
Yu Shen, Yanqiong Wen, Liang Bi, Xuyang Yang, Xiaoling Gong, Xiangbing Deng, Wenjian Meng, Ziqiang Wang
Abdominal Radiology.2023; 49(3): 774. CrossRef
Pathology and Prognosis of Colonic Adenocarcinomas With Intermediate Primary Tumor Stage Between pT2 and pT3
John D. Paulsen, Alexandros D. Polydorides
Archives of Pathology & Laboratory Medicine.2022; 146(5): 591. CrossRef
Prognostic significance of additional histologic features for subclassification of pathological T3 colon cancer
Lorenzo Macchi, Quoc Riccardo Bao, Laura Albertoni, Matteo Fassan, Valentina Chiminazzo, Marco Scarpa, Gaya Spolverato, Salvatore Pucciarelli
International Journal of Clinical Oncology.2022; 27(9): 1428. CrossRef
The value of diffusion kurtosis imaging and intravoxel incoherent motion quantitative parameters in predicting synchronous distant metastasis of rectal cancer
Xue Ding, Danqi Sun, Qiuchen Guo, Yeting Li, Hao Chen, Xiaoxiao Dai, Guohua Fan, Yongyou Wu, Guangqiang Chen, Yonggang Li
BMC Cancer.2022;[Epub] CrossRef
The 2017 Assisi Think Tank Meeting on rectal cancer: A positioning paper
Vincenzo Valentini, Corrie Marijnen, Geerard Beets, Krzysztof Bujko, Berardino De Bari, Andres Cervantes, Giuditta Chiloiro, Claudio Coco, Maria Antonietta Gambacorta, Robert Glynne-Jones, Karin Haustermans, Elisa Meldolesi, Femke Peters, Claus Rödel, Har
Radiotherapy and Oncology.2020; 142: 6. CrossRef
Whole-lesion Apparent Diffusion Coefficient First- and Second-Order Texture Features for the Characterization of Rectal Cancer Pathological Factors
Weifeng Li, Zhuoran Jiang, Yue Guan, Ying Chen, Xiaolin Huang, Song Liu, Jian He, Zhengyang Zhou, Yun Ge
Journal of Computer Assisted Tomography.2018; 42(4): 642. CrossRef
A meta-analysis assessing the survival implications of subclassifying T3 rectal tumours
M.R.S. Siddiqui, C. Simillis, J. Bhoday, N.J. Battersby, J. Mok, S. Rasheed, P. Tekkis, A.M. Abulafi, G. Brown
European Journal of Cancer.2018; 104: 47. CrossRef
Extramural extension as indicator for postoperative adjuvant chemotherapy in Stage IIA (pT3N0) colon cancer
Yoshito Akagi, Kazuo Shirouzu, Tetsushi Kinugasa
Journal of Surgical Oncology.2013; 108(6): 358. CrossRef
T3 Subdivision Correlation with Nodal or Distant Metastasis in Colorectal Cancer; Is It Practically Useful?
Nam Kyu Kim
Journal of the Korean Society of Coloproctology.2012; 28(3): 119. CrossRef

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