Pre-Operative Radiological Diagnosis of Appendiceal Neuroendocrine Neoplasms: Implications for Conservative Management of Acute Appendicitis

Abstract

Background

Non-surgical treatment of appendicitis carries the risk of missed tumors, such as appendiceal neuroendocrine neoplasms (ANEN), the most common appendiceal tumor. The aim of this study is to identify radiological features of ANEN that will distinguish them from simple acute appendicitis.

Methods

Data were extracted from a database of 8327 appendectomies conducted during 2005–2018. Pre-operative computerized tomography (CT) or ultrasound (US) scans of patients with ANEN and a random sample of patients with simple appendicitis were compared. Patients with other appendiceal tumors were excluded. All images were reviewed by a blinded, experienced radiologist.

Results

Thirty-five ANEN (20 CT, 15 US) were compared to 50 cases with simple appendicitis (30 CT, 20 US). Age was similar between study groups (33.8 ± 19.2 vs. 35.2 ± 17.9, respectively, p = 0.378); female gender was more prevalent in the ANEN group (65.7% vs. 38.3%, p = 0.017). ANEN size per pathology report was 17.0 ± 13.4 mm, and mesoappendix invasion was evident in 37.1%. Appendiceal diameter, regional lymph node number, and size were similar. Evidence of solid tissue in the appendiceal lumen per CT was more prevalent in the ANEN group compared to controls (7/20 [35%] vs. 2/30 [6.7%], p = 0.0008).

Conclusions

Although the majority of ANEN cannot be identified in pre-appendectomy imaging, 35% of cases demonstrate the presence of solid tissue in the appendiceal lumen. This finding may distinguish these patients from those with simple appendicitis and should lead to early surgical intervention, or close and more cautious surveillance if a conservative approach is chosen.