Annals of Surgical Oncology

, Volume 24, Issue 12, pp 3667–3672 | Cite as

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

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

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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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Tara L. Sagebiel
    • 1
  • Amr Mohamed
    • 2
  • Aurelio Matamoros
    • 1
  • Melissa W. Taggart
    • 1
  • Fred Doamekpor
    • 3
  • Kanwal P. Raghav
    • 1
  • Gary N. Mann
    • 1
  • Paul F. Mansfield
    • 1
  • Cathy Eng
    • 1
  • Richard E. Royal
    • 1
  • Wai Chin Foo
    • 1
  • Joe E. Ensor
    • 4
  • Keith F. Fournier
    • 1
  • Michael J. Overman
    • 1
  1. 1.Department of Diagnostic RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Wayne State University, Karmanos Cancer InstituteDetroitUSA
  3. 3.Morehouse School of MedicineAtlantaUSA
  4. 4.Houston Methodist Research InstituteHoustonUSA

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