Appendix cancer diagnostic study of choice: Difference between revisions

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== Overview ==
== Overview ==
Either CT-scan or MRI are diagnostic study of choice for appendix cancer.  
Either [[Computed tomography|CT-scan]] or [[Magnetic resonance imaging|MRI]] are diagnostic study of choice for [[Vermiform appendix|appendix]] [[cancer]]. Both [[Magnetic resonance imaging|MRI]] ([[MRI sequences|particularly diffusion weighted MRI]]) and [[Computed tomography|CT scan]] has been recommended as method of choice for disease staging. [[Histopathology]] is the [[Gold standard (test)|gold standard]] test for the [[diagnosis]] as well as classification of [[Vermiform appendix|appendix]] [[Cancer|cancers]].  
 
Histopathology is the gold standard test for the diagnosis of appendix cancer.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== 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.
*Either [[Computed tomography|CT-scan]] or [[Magnetic resonance imaging|MRI]] are diagnostic study of choice for [[Vermiform appendix|appendix]] [[cancer]].<ref name="pmid22302265" /> 
 
*Both [[Magnetic resonance imaging|MRI]] ([[MRI sequences|particularly diffusion weighted MRI]]) and [[Computed tomography|CT scan]] has been recommended as method of choice for [[Cancer staging|disease staging]].  


Histopathology is the gold standard test for the diagnosis of appendix cancer.
*[[Peritoneal carcinomatosis]] index (PCI) using either '''[[Computed tomography|CT-scan]]''' or preferably '''diffusion weighted [[Magnetic resonance imaging|MRI]]''' has been globally accepted to determine disease burden in appendix cancer.


Investigations:
*[[Histopathology]] is the [[Gold standard (test)|gold standard test]] for the diagnosis as well as classification of [[appendix cancer]].
* 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 [[carcinoid syndrome]], [[somatostatin]] [[scintigraphy]] with 111-indium-[[octreotide]] and serum [[5-Hydroxyindoleacetic acid|5-HIAA]] levels are the most specific tests for the [[Diagnosis|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 [[appendicitis]], the [[Computed tomography|CT-scan]] is the most [[Sensitivity (tests)|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 ===
*'''''Peritoneal carcinomatosis index (PCI):''' a widely accepted metric for assessment of disease border in appendix cancer''<ref name="pmid8849962">Jacquet P, Sugarbaker PH (1996) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8849962 Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis.] ''Cancer Treat Res'' 82 ():359-74. PMID: [https://pubmed.gov/8849962 8849962]</ref>
*'''''Peritoneal carcinomatosis index (PCI):''' A widely accepted metric for assessment of disease border in appendix cancer:''<ref name="pmid8849962">Jacquet P, Sugarbaker PH (1996) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8849962 Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis.] ''Cancer Treat Res'' 82 ():359-74. PMID: [https://pubmed.gov/8849962 8849962]</ref>
** Estimated by contrast enhanced cross sectional imaging.
:* Estimated by contrast enhanced cross sectional imaging.
** Both MRI and CT scan has been used and are globally accepted imaging modalities.
:* Both [[Magnetic resonance imaging|MRI]] and [[Computed tomography|CT scan]] has been used and are globally accepted [[Imaging studies|imaging modalities]].
** Small peritoneal seeding might be difficult to appreciate on CT.
:* Small [[Peritoneal carcinomatosis|peritoneal seeding]] might be difficult to appreciate on [[Computed tomography|CT]].
** Sometimes it is challenging to distinguish between tumor and mucin.  
:* 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.<ref name="pmid22302265">Low RN, Barone RM (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22302265 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. [http://dx.doi.org/10.1245/s10434-012-2236-3 DOI:10.1245/s10434-012-2236-3] PMID: [https://pubmed.gov/22302265 22302265]</ref>
:* There are reports in favor of diffusion weighted [[Magnetic resonance imaging|MRI]] superiority compared to [[Computed tomography|CT]] in evaluating extent of [[Peritoneal carcinomatosis|peritoneal involvement]].<ref name="pmid22302265">Low RN, Barone RM (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22302265 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. [http://dx.doi.org/10.1245/s10434-012-2236-3 DOI:10.1245/s10434-012-2236-3] PMID: [https://pubmed.gov/22302265 22302265]</ref>


**'''''Table and figure below demonstrate abdominal regions as well as scoring system for PCI.'''''
:*'''''Table and figure below demonstrate abdominal regions as well as scoring system for [[Peritoneal carcinomatosis|PCI]].'''''


[[Image:Peritoneal Carcinomatosis Index (PCI) Regions.jpg|thumb|left|'''Peritoneal Carcinomatosis Index (PCI) Regions'''|400px|right|Peritoneal Carcinomatosis Index (PCI) Regions]]  
[[Image:Peritoneal Carcinomatosis Index (PCI) Regions.jpg|thumb|left|'''Peritoneal Carcinomatosis Index (PCI) Regions'''|850px|right|Peritoneal Carcinomatosis Index (PCI) Regions]]  
{| class="wikitable"
{| class="wikitable"
|+PCI Scoring System
|+ style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|PCI Scoring System}}
! colspan="2" |Lesion Size Score
! colspan="2" |Lesion Size Score
|-
|-
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|}
|}


-------------------------------
===TNM classification of tumors of the appendix===


*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.<ref name="WHO">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</ref>   
*Major [[Prognosis|prognos]]<nowiki/>tic factors are tumor [[Cancer staging|stage]], tumor size, [[Histology|histologic]] as well [[Genetics|genetic]] characteristics of appendiceal [[Tumor|tumors]].
*[[TNM|TNM classification of tumors of the appendix]] has been shown in the table below.<ref name="WHO">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</ref>   


{| class="wikitable"
{| class="wikitable"
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''or lamina propria (intramucosal) with no extension through muscularis mucosae into submucosa.''
''or lamina propria (intramucosal) with no extension through muscularis mucosae into submucosa.''
|}
|}
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
===== 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==
==References==
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Latest revision as of 17:48, 22 February 2019

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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. 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 cancers.

Diagnostic Study of Choice

Study of choice

Peritoneal carcinomatosis index

  • Peritoneal carcinomatosis index (PCI): A widely accepted metric for assessment of disease border in appendix cancer:[2]
  • 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

TNM classification of tumors of the appendix

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.

References

  1. ↑ 1.0 1.1 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
  2. ↑ 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
  3. ↑ 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

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