The correlation between computed tomography reports and histopathological results in acute appendicitis

Aim: Preoperative correct diagnosis is very important in reducing negative appendectomy rates. In patients with suspected acute appendicitis (AA), computed tomography (CT) is frequently preferred along with other diagnostic methods to reduce diagnostic uncertainty. The aim of this study is to evaluate the diagnostic performance of CT findings in the histological findings of AA. Material and Methods: In this study, 319 patients who underwent abdominopelvic CT imaging between January 1, 2017 and May 1, 2022 and who were operated due to AA suspicion were evaluated retrospectively. CT imaging findings, such as appendix diameter, presence of appendicolith, appendix wall thickening, heterogeneity in periappendicular fatty tissue, presence of fluid accumulation/abscess and lymphadenopathy in the right lower quadrant were evaluated. Only patients who were operated due to the suspicion of AA in CT findings were included in the study. Results: The mean age of the patients was 36.1 +/- 14.7 years. In the study, the male/female ratio was 1.7/1. In CT imaging, appendix diameter (AUC=0.997), heterogeneity in fatty tissue (AUC= 0.704), appendicolith (AUC= 0.702) and appendix wall thickening (AUC=0.671) were found to be determinants in gangrenous appendicitis compared to normal histology. Discussion: Appendiceal diameter (over 9 mm) was found to be a determinant in gangrenous appendicitis with 100% sensitivity and 92.9% specificity. Appendicolith (AUC=0.619) and appendix wall thickening (AUC=0.593) had high sensitivity in appendix neoplasms, but their specificity was quite low (23.7% and 18.5%, respectively). Histologically, preoperative CT findings may be useful indicators in the diagnosis of gangrenous appendicitis.