Appendix cancer diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

Either CT-scan or MRI are diagnostic study of choice for appendix cancer.

Histopathology is the gold standard test for the diagnosis of appendix cancer.

Diagnostic Study of Choice

Study of choice

CT-scan/MRI are diagnostic study of choice for appendix cancer. Peritoneal carcinomatosis index (PCI) using either CT-scan or preferably diffusion weighted MRI has been recommended to determine disease burden.

Histopathology is the gold standard test for the diagnosis of appendix cancer.

Investigations:

• Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
• Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
• Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.

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• Peritoneal carcinomatosis index (PCI): a widely accepted metric for assessment of disease border in appendix cancer
  • Estimated by contrast enhanced cross sectional imaging.
  • Both MRI and CT scan has been used and are globally accepted imaging modalities.
  • Small peritoneal seeding might be difficult to appreciate on CT.
  • Sometimes it is challenging to distinguish between tumor and mucin.
  • There are reports in favor of diffusion weighted MRI superiority compared to CT in evaluating extent of peritoneal involvement.

• • Table and figure below demonstrate abdominal regions as well as scoring system for PCI.

Peritoneal Carcinomatosis Index (PCI) Regions

PCI Scoring System

Lesion Size Score
LS0	No tumor seen
LS1	Tumor up to 0.5 cm
LS2	Tumor up to 5 cm cm
LS3	Tumor > 5 cm or confluence
Maximum Score = 3
Regions (0-3)
0	Central
1	Right Upper
2	Epigasterium
3	Left Upper
4	Left Flank
5	Left Lower
6	Pelvis
7	Right Upper
8	Right Flank
9	Upper Jejunum
10	Lower Jejunum
11	Upper Illeum
12	lower Illeum
Maximum Score = 36
Total Maximum Score = 39

The comparison of various diagnostic studies for [disease name]

Test	Sensitivity	Specificity
Test 1	...%	...%
Test 2	...%	...%

[Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity

Diagnostic results

The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:

• [Finding 1]
• [Finding 2]

Sequence of Diagnostic Studies

The [name of investigation] must be performed when:

• The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
• A positive [test] is detected in the patient, to confirm the diagnosis.

OR

The various investigations must be performed in the following order:

• [Initial investigation]
• [2nd investigation]

Name of Diagnostic Criteria

It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.

[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].

OR

There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].

OR

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

[Disease name] may be diagnosed at any time if one or more of the following criteria are met:

• Criteria 1
• Criteria 2
• Criteria 3

OR

IF there are clear, established diagnostic criteria

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

IF there are no established diagnostic criteria

There are no established criteria for the diagnosis of [disease name].