Abstract
Background: The misdiagnosis of appendiceal cancer as inflammatory appendicitis is becoming of greater clinical concern because of the rise of nonoperative management especially in the elder population. To quantify this rate of misdiagnosis, we retrospectively reviewed SEER-Medicare data. Methods: The SEER-Medicare database was reviewed from 2000 to 2014. We identified patients older than 65 years old who were diagnosed with appendiceal cancer and then cross-referenced them for a diagnosis of inflammatory appendicitis. Demographic data and oncologic stage were collected. Results: Our results showed that 28.6% of appendiceal cancer patients received an incorrect initial diagnosis of inflammatory appendicitis. Patients older than 75 years of age were more likely to be misdiagnosed than those between ages 65 and 75 (risk ratio [RR]: 0.81; 95% confidence interval: 0.70-0.93; P =.003). We found that 42% of patients within the misdiagnosis group presented with an earlier stage of disease (stage 1 or 2) compared to 26% of those primarily diagnosed with appendiceal cancer (P <.001). Conclusion: A significant proportion of patients older than 65 years old with appendiceal cancer were initially misdiagnosed with acute appendicitis. We suggest caution when considering a nonoperative approach for appendicitis in the elderly and follow-up imaging or an interval appendectomy should be part of the treatment plan.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 736-739 |
| Number of pages | 4 |
| Journal | Journal of surgical oncology |
| Volume | 120 |
| Issue number | 4 |
| DOIs | |
| State | Published - Jan 1 2019 |
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Keywords
- appendiceal cancer
- appendicitis
- misdiagnosis
- SEER-Medicare
ASJC Scopus subject areas
- Surgery
- Oncology
Cite this
Appendiceal cancer masked as inflammatory appendicitis in the elderly, not an uncommon presentation (Surveillance Epidemiology and End Results (SEER)-Medicare Analysis). / Siddharthan, Ragavan V.; Byrne, Raphael M.; Dewey, Elizabeth; Martindale, Robert; Gilbert, Erin; Tsikitis, Vassiliki.
In: Journal of surgical oncology, Vol. 120, No. 4, 01.01.2019, p. 736-739.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Appendiceal cancer masked as inflammatory appendicitis in the elderly, not an uncommon presentation (Surveillance Epidemiology and End Results (SEER)-Medicare Analysis)
AU - Siddharthan, Ragavan V.
AU - Byrne, Raphael M.
AU - Dewey, Elizabeth
AU - Martindale, Robert
AU - Gilbert, Erin
AU - Tsikitis, Vassiliki
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: The misdiagnosis of appendiceal cancer as inflammatory appendicitis is becoming of greater clinical concern because of the rise of nonoperative management especially in the elder population. To quantify this rate of misdiagnosis, we retrospectively reviewed SEER-Medicare data. Methods: The SEER-Medicare database was reviewed from 2000 to 2014. We identified patients older than 65 years old who were diagnosed with appendiceal cancer and then cross-referenced them for a diagnosis of inflammatory appendicitis. Demographic data and oncologic stage were collected. Results: Our results showed that 28.6% of appendiceal cancer patients received an incorrect initial diagnosis of inflammatory appendicitis. Patients older than 75 years of age were more likely to be misdiagnosed than those between ages 65 and 75 (risk ratio [RR]: 0.81; 95% confidence interval: 0.70-0.93; P =.003). We found that 42% of patients within the misdiagnosis group presented with an earlier stage of disease (stage 1 or 2) compared to 26% of those primarily diagnosed with appendiceal cancer (P <.001). Conclusion: A significant proportion of patients older than 65 years old with appendiceal cancer were initially misdiagnosed with acute appendicitis. We suggest caution when considering a nonoperative approach for appendicitis in the elderly and follow-up imaging or an interval appendectomy should be part of the treatment plan.
AB - Background: The misdiagnosis of appendiceal cancer as inflammatory appendicitis is becoming of greater clinical concern because of the rise of nonoperative management especially in the elder population. To quantify this rate of misdiagnosis, we retrospectively reviewed SEER-Medicare data. Methods: The SEER-Medicare database was reviewed from 2000 to 2014. We identified patients older than 65 years old who were diagnosed with appendiceal cancer and then cross-referenced them for a diagnosis of inflammatory appendicitis. Demographic data and oncologic stage were collected. Results: Our results showed that 28.6% of appendiceal cancer patients received an incorrect initial diagnosis of inflammatory appendicitis. Patients older than 75 years of age were more likely to be misdiagnosed than those between ages 65 and 75 (risk ratio [RR]: 0.81; 95% confidence interval: 0.70-0.93; P =.003). We found that 42% of patients within the misdiagnosis group presented with an earlier stage of disease (stage 1 or 2) compared to 26% of those primarily diagnosed with appendiceal cancer (P <.001). Conclusion: A significant proportion of patients older than 65 years old with appendiceal cancer were initially misdiagnosed with acute appendicitis. We suggest caution when considering a nonoperative approach for appendicitis in the elderly and follow-up imaging or an interval appendectomy should be part of the treatment plan.
KW - appendiceal cancer
KW - appendicitis
KW - misdiagnosis
KW - SEER-Medicare
UR - http://www.scopus.com/inward/record.url?scp=85070736186&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85070736186&partnerID=8YFLogxK
U2 - 10.1002/jso.25641
DO - 10.1002/jso.25641
M3 - Article
C2 - 31309554
AN - SCOPUS:85070736186
VL - 120
SP - 736
EP - 739
JO - Journal of Surgical Oncology
JF - Journal of Surgical Oncology
SN - 0022-4790
IS - 4
ER -