Through Different Lenses: A Retrospective Analysis of the Agreement Between Laparoscopic and Histopathological Evaluations of the Appendix

TL;DR

This study compares surgeons' laparoscopic assessments of the appendix with histopathology results and finds good agreement in detecting abnormalities but poor detection of tumors.

Contribution

The study provides a retrospective analysis of diagnostic agreement between laparoscopic and histopathological evaluations of appendices.

Findings

There was substantial agreement (kappa = 0.71) between laparoscopic and histopathological assessments of appendiceal abnormalities.

Only two of six neoplastic lesions were suspected during laparoscopy, indicating poor detection of tumors.

Routine histopathological examination is recommended to avoid missed diagnoses and improve patient outcomes.

Abstract

Background: Appendicectomy is the most frequently performed emergency general surgical procedure. Previous research has highlighted discrepancies between initial intraoperative laparoscopic diagnoses and subsequent histopathology reports following appendicectomy. In the United Kingdom (UK), routine histopathological examination is the established practice, ensuring precise diagnosis of appendiceal specimens. This retrospective analysis aims to compare intraoperative laparoscopic assessments of the appendix with corresponding histopathology findings.

Methodology: We conducted a retrospective analysis of 418 consecutive emergency laparoscopic appendectomies at Peterborough City Hospital in the UK between April 2018 and June 2019 for suspected appendicitis. Intraoperative findings were compared with histopathological examination outcomes using kappa statistics.

Results: Of the 418 appendectomies analysed, we found a substantial agreement between surgeons and pathologists (kappa = 0.71, P < 0.001) in detecting overall abnormalities of appendices. This agreement was also high for detecting inflamed appendices (kappa = 0.72, P < 0.001). However, of the six neoplastic lesions confirmed in the pathologists' final report, only two were suspected during laparoscopy.

Conclusions: While laparoscopic assessments of the appendix demonstrate a statistically significant and improved agreement with histopathological findings in detecting abnormal and inflamed appendices, the ability of surgeons to identify neoplasia appears suboptimal based on our small sample of neoplasia cases. The data strongly support the continued practice of routine histopathological examination following appendicectomy due to its crucial role in avoiding missed diagnoses and ensuring better patient outcomes.

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