Appendix cancer diagnostic study of choice: Difference between revisions
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Histopathology is the gold standard test for the diagnosis as well as classification of appendix cancer. | Histopathology is the gold standard test for the diagnosis as well as classification of appendix cancer. | ||
* Among the patients who present with clinical signs of carcinoid syndrome, the | * Among the patients who present with clinical signs of carcinoid syndrome, the in-oct scan is the most specific test for the diagnosis. | ||
* Among the patients who present with clinical signs of | * Among the patients who present with clinical signs of appendicitis, the CT-scan 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. | * Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis. | ||
Revision as of 20:42, 25 January 2019
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Appendix cancer Microchapters |
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Diagnosis |
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Treatment |
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Appendix cancer diagnostic study of choice On the Web |
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American Roentgen Ray Society Images of Appendix cancer diagnostic study of choice |
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Risk calculators and risk factors for Appendix cancer diagnostic study of choice |
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. Both MRI ( particularly diffusion weighted MRI) and CT scan has been recommended as method of choice for disease staging. Histopathology is the gold standard test for the diagnosis as well as classification of appendix cancer.
Diagnostic Study of Choice
Study of choice
Either CT-scan or MRI are diagnostic study of choice for appendix cancer.
Both MRI ( particularly diffusion weighted MRI) and CT scan has been recommended as method of choice for disease staging.
Peritoneal carcinomatosis index (PCI) using either CT-scan or preferably diffusion weighted MRI has been globally accepted to determine disease burden in appendix cancer.
Histopathology is the gold standard test for the diagnosis as well as classification of appendix cancer.
- Among the patients who present with clinical signs of carcinoid syndrome, the in-oct scan is the most specific test for the diagnosis.
- Among the patients who present with clinical signs of appendicitis, the CT-scan 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.
- Peritoneal carcinomatosis index (PCI): a widely accepted metric for assessment of disease border in appendix cancer[1]
- 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.[2]
- Table and figure below demonstrate abdominal regions as well as scoring system for PCI.
_Regions.jpg)
| 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 | |
- Major prognostic factors are tumor stage, tumor size, histologic as well genetic characteristics of appendiceal tumors. TNM classification of tumors of the appendix has been shown in the Table below.[3]
| TNM classification of tumors of the appendix 1 | |
|---|---|
| Primary tumor (T) | |
| Tx | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| Tis | Carcinoma in situ: intraepithelial or invasion of lamina propria 2 |
| T1 | Tumor invades submucosa |
| T2 | Tumour invades muscularis propria |
| T3 | Tumor invades through muscularis propria into subserosa,
or into non-peritonealized periappendiceal tissue |
| T4 | Tumor directly invades other organs or structures
and/or perforates visceral peritoneum |
| Regional Lymph Nodes (N) | |
| Nx | Regional lymph nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis in 1 to 3 regional lymph nodes |
| N2 | Metastasis in 4 or more regional lymph nodes |
| Distant Metastasis (M) | |
| Mx | Distant metastasis cannot be assessed |
| M0 | No distant metastasis |
| M1 | Distant metastasis |
| Stage Grouping | |
| Stage 0 | Tis N0 M0 |
| Stage I | T1 N0 M0
T2 N0 M0 |
| Stage II | T3 N0 M0
T4 N0 M0 |
| Stage III | Any T N1 M0
Any T N2 M0 |
| Stage IV | Any T Any N M1 |
| 1 The classification applies only to carcinomas.
2 This includes cancer cells confined within the glandular basement membrane (intraepithelial) or lamina propria (intramucosal) with no extension through muscularis mucosae into submucosa. | |
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].
References
- ↑ Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82 ():359-74. PMID: 8849962
- ↑ Low RN, Barone RM (2012) Combined diffusion-weighted and gadolinium-enhanced MRI can accurately predict the peritoneal cancer index preoperatively in patients being considered for cytoreductive surgical procedures. Ann Surg Oncol 19 (5):1394-1401. DOI:10.1245/s10434-012-2236-3 PMID: 22302265
- ↑ Chapter 5: Tumours of the Appendix - IARC. https://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb2/bb2-chap5.pdf Accessed on January 15, 2019