Abstract
The aim of the study was to investigate the clinical significance of various histomorphologic findings related to mucosal inflammation in negative appendectomy. We reviewed histopathologic findings of 118 negative appendectomies and correlated them with the appendicitis inflammatory response (AIR) score and appendiceal diameter. Among 118 patients with negative appendectomy, 94 (80%), 73 (78%) and 89 (75%) patients displayed mucosal inflammation, high neutrophil score (neutrophil count ≥10/5 high power field and surface epithelial flattening, respectively. Out of 118 patients with negative appendectomy, mucosal inflammation, high neutrophil score and surface epithelial flattening were associated with higher risk group according to the appendicitis inflammatory response (AIR) score (p < 0.05, respectively). In addition, mucosal inflammation, high neutrophil score and surface epithelial flattening were frequently detected in 118 negative appendectomies, compared with 24 incidental appendectomies (p < 0.05, respectively). In an analysis of 77 negative appendectomy patients with appendiceal diameter data available, increased appendiceal diameter was positively correlated with luminal inflammation, high neutrophil score and surface epithelial flattening (p < 0.05, respectively). In conclusion, mucosal inflammation, high neutrophil score and surface epithelial flattening in negative appendectomy may be relevant to patients’ signs and symptoms, especially in cases with no other cause of the abdominal pain.
Highlights
The diagnosis of acute appendicitis (AA) is often challenging due to ambiguous symptoms that can result from other diseases
Many pathologists agree that the diagnosis of acute appendicitis requires intramural neutrophilic infiltration, because mucosal neutrophilic infiltration can often be shown in incidental appendectomy specimens [7,16]
We correlated the appendicitis inflammatory response (AIR) score and variable histologic findings in negative appendectomy specimens according to the presence or absence of mucosal inflammation and compared the histologic findings between negative appendectomy and incidental appendectomy to identify the clinical significance of various histologic features in negative appendectomy specimens
Summary
The diagnosis of acute appendicitis (AA) is often challenging due to ambiguous symptoms that can result from other diseases. Several clinical scoring systems have been proposed to improve the diagnostic accuracy of AA [1,2,3], and the Alvarado score is most well established. The Alvarado score predicts likelihood of AA, based on three symptoms (migratory pain, anorexia and nausea or vomiting), three signs (right lower quadrant pain, rebound tenderness and elevated temperature) and two laboratory findings (leukocytosis and shift to left). The appendicitis inflammatory response (AIR) score, which incorporates C-reactive protein (CRP) and gradation of RLQ pain, was proven to outperform the Alvarado score in several studies [3,4,5]. In the previous study on the diagnostic performance of the risk stratification using AIR score, intermediate and high risk (AIR score of 5 or more) showed high sensitivity for AA and high risk (AIR score of 9 or more) was very specific for AA [6]
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