NÖTROFİL LENFOSİT ORANI İLE RADYOLOJİK YÖNTEMLERİN KOMBİNASYONUNUN AKUT APANDİSİT TANISINDAKİ DEĞERİ

Abstract

AMAÇ: Akut apandisit tanısında anamnez ve fzik muayene bulgularının yanısıra laboratuvar tetkikleri ve görüntüleme yöntemlerinin kullanılması da tanıya yardımcıdır. Çalışmamızda nötrofil lenfosit oranını (NLO) abdominal ultrasonografi (USG) ve bilgisayarlı tomografi (BT) ile kombine ederek akut apandisit tanısındaki değerini araştırmayı amaçladık.

GEREÇ VE YÖNTEMLER: Çalışmamız Haziran 2014-Aralık 2016 tarihleri arasında S.B. Ankara Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniğinde akut apandisit tanısıyla opere edilen 1340 hasta dahil edildi. Tüm hastaların demografik verileri NLO değerleri abdominal USG ile BT raporları ve patoloji raporları retrospektif olarak analiz edildi.

BULGULAR: Hastaların 764’ü erkek (%57), 576’sı kadın (%43), ortalama yaş 34,8 (17-92) idi. Patolojik tanıların 1128’i (%84,2) akut apandisit, 212’si (%15,8) normal apendiks olarak raporlandı. Çalışmamızda NLO değerinin cut-off değeri 3,17, duyarlılılğı tüm hastalarda %77,3, erkek hastalarda%84,8, kadın hastalarda %58,4 bulundu. USG’nin duyarlılığı tüm hastalarda %60, erkek hastalarda %61,7, kadın hastalarda %57,7; BT’nin duyarlılığı tüm hastalarda %63,3, erkek hastalarda %69,7, kadın hastalarda %55,1 bulundu. NLO<3,17+USG duyarlılığı%55,9, NLO<3,17+BT duyarlılığı%64,9, NLO>3,17+USG duyarlılığı %60,9, NLO>3,17+BT duyarlılığı %64,9 olarak bulundu.

SONUÇ: Yardımcı tanı yöntemlerinin akut apandisit tanısında tanısal değeri ve yol göstericiliği olmakla birlikte gerekli klinik durumlarda cerrahın tecrübesi ön plana çıkarak karar verilmelidir. 

Keywords

• Akut apandisit,tanı,nötrofil/lenfosit oranı,görüntüleme yöntemleri

DIAGNOSTIC VALUE OF COMBINATION OF NEUTROPHYL TO LYMPHOCYTE RATIO WITH IMAGING METHODS IN THE ACUTE APENDICITIS

Abstract

OBJECTIVE: The use of laboratory tests and imaging methods as well as history of patient and physical examination findings are helpful in the diagnosis of acute appendicitis. We aimed to investigate value of combination neutrophyl to lymphocyte ratio (NLR) with abdominal ultrasonography (USG) and computed tomography (CT) in the diagnosis of acute appendicitis.

MATERIALS AND METHODS: Our study was conducted on 1340 patients who were underwent appendectomy in the General Surgery Clinic of Ankara Training and Research Hospital between June 2014 and December 2016 . Demographic datas, NLR values, abdominal USG with CT reports and pathology reports of all patients were analyzed retrospectively.The data obtained were evaluated in the IBM SPSS statistical package program.

RESULTS: Of all patients,764 (57%) were male , 576 (43%) were female and the mean age was 34,8 (17-92). 1128 (84.2%) of the pathologic diagnoses were reported as acute appendicitis and 212 (15.8%) were normal appendicitis. In our study, the cut-off value of NLR was 3.17, sensitivity was 77.3% in all patients, 84.8% in male patients and 58.4% in female patients. The sensitivity of USG is 60% in all patients, 61.7% in male patients, 57.7% in female patients; The sensitivity of CT was 63.3% in all patients, 69.7% in male patients and 55.1% in female patients. NLR <3,17 + USG sensitivity 55,9%, NLR <3,17 + BT sensitivity 64,9%, NLR 3,17 + USG sensitivity 60,9%, NLR 3,17 + BT sensitivity 64,9% was found.

CONCLUSION: The combination of NLR values with imaging methods in the diagnosis of acute appendicitis may be helpful but the surgeon should determine in doubtful cases by experience.

Keywords

• acute appendicitis,diagnosis,neutrophil lymphocyte ratio,imaging methods

References

1. 1. Young P. Appendicitis and its history. Rev Med Chil. 2014; 142: 667-72.
2. 2. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990; 132: 910–25.
3. 3. Jaffe BM, Berger DH. The Appendix. In: Schwartz’s. Principles of surgery 8nd ed. 2008; 29: 1162.
4. 4. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986; 15: 557-64.
5. 5. Birchley D. Patients with Clinical Acute Appendicitis Should Have Pre-Operative Full Blood Count And C-Reaktive Protein Assays. Ann R Coll Surg Engl. 2006; 88: 27-32.
6. 6. Goodman DA, Goodman CB, Monk JS. Use of the neutrophil: lymphocyte ratio in the diagnosis of appendicitis. Am Surg. 1995; 61: 257-9.
7. 7. Markar SR, Karthikesalingam A, Falzon A, Kan Y. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg. 2010; 110: 543-7.
8. 8. Kahramanca Ş, Özgehan G, Şeker D, et al. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Ulus Travma Acil Cerr Derg. 2014; 20: 19-22.

9. 9. See TC, Ng CS, Watson CJ, Dixon AK. Appendicitis: spectrum of appearences on helical CT. Br J Radiol. 2002; 75: 775-81.
10. 10. Behzatoğlu B, Hatipoğlu E, Bayramoğlu S, Yılmaz G, Yirik G, Cimilli T. Akut Apandisit tanısında ultrasonografi ve bilgisyarlı tomografi bulgularının karşılaştırılması. Bakırköy Tıp Dergisi .2006; 2: 22-4.
11. 11. Zoarets I, Polaksht N, Halevy A. Does selective use of computed tomography scan reduce the rate of ‘’white’’ (negative) appendectomy? Isr Med Assac J. 2014; 16: 335-7.
12. 12. Masoomi H, Nguyen NT, Dolich MO, Mills S, Carmichael JC, Stamos MJ. Laparoscopic appendectomy trends and outcomes in the United States: data from the Nationwide Inpatient Sample (NIS), 2004–2011. Am Surg. 2014; 80: 1074-77.
13. 13. Marudanagayam R, Williams GT, Rees BI. Review of the pathological results of 2660 appendicectomy specimens. J Gastroenterol. 2006; 41: 745-9.
14. 14. Nshuti R, Kruger D, Luvhengo TE. Clinical presentation of acute appendicitis in adults at the Chris Hani Baragwanath academic hospital. Int J Emerg Med. 2014; 7: 12-3.
15. 15. Franz MG, Norman J, Fabri PJ. Increased morbidity of appendicitis with advancing age. Am Surg. 1995; 61: 40-4.
16. 16. Çitgöz B, Yetkin G, Akgün İ, Uludağ M, Velidedeoğlu M, Akçakaya A. Kadın Hastalarda Negatif Apendektomi ile Jinekolojik Patolojiler arasındaki ilişki. Maltepe Tıp Derg. 2011; 3: 10-2.
17. 17. Acar E, Özcan Ö, Deliktaş H, et al. Laboratory markers has many valuable parameters in the discrimination between acut appendicitis and renal colic. Ulus Travma Acil Cerrahi Derg. 2016; 22: 17-22.
18. 18. Naci H,Turk E, Karagulle E, Togan T, Karabulut K. The role of mean platelet volüme in the diagnosis of acute appendicitis; a retrospective case-controlled study. Iran Red Crescent Med. 2013; 15: 11934.
19. 19. Birnbaum BA, Wilson SR. Appendicitis at the Millenium. Radiology. 2000; 215: 337-48.
20. 20. Humes DJ, Simpson J. Acute Appendicitis. BMJ. 2006; 333: 530-4.
21. 21. Bergeron E. Clinical judgementremains of great value in the diagnosis of acute appendicitis. Can J Surg. 2006; 49: 96-100.
22. 22. Lee JF, Leow CK, Lau WY. Appendicitis in the elderly. Aust NZJ Surg. 2000; 70: 593-6.
23. 23. Zahorec R. Ratio of neutrophil to lymphocyte counts—Rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001; 102: 5-14.
24. 24. Shimizu T, Ishizuka M, Kubota K. A lower neutrophil to lymphocyte ratio is closely, associated with catarrhal appendicitis versus severe appendicitis. Surg Today. 2016; 46: 84-9.
25. 25. Tatli F, Ekici U, Kanlioz M,et al. Ultrasonography in diagnosis of acute appendicitis. Ann Ital Chir. 2016; 87: 152-4.
26. 26. Tarján Z1, Makó E, Winternitz T, Kiss I, Kálmán A. The value of ultrasonic diagnosis in acute appendicitis. Orv Hetil. 1995; 136: 713-7.
27. 27. Raptopoulos V, Katsou G, Rosen MP, Siewert B, Goldberg SN, Kruskal JB. Acute appendicitis: effect of increased use of CT on selecting patients earlier. Radiology. 2003; 226: 521-6.
28. 28. Lane MJ, Liu DM, Huynh MD, Jeffrey RB Jr, Mindelzun RE, Katz DS. Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients. Radiology. 1999; 213: 341-6.
29. 29. Ergün E, Bilaloğlu P, Koşar U,Ünlübay D, Temel S. Akut apandisit tanısında opaksız spiral BT incelemesinin yeri, USG ve cerrahi sonuçları ile karşılaştırılması. Türk J Diagn Intervent Radiol. 2002; 8: 231-6.