Partial Pathology of Appendix Appears Adequate for Older Patients

September 27, 2019

By Alex Morrisson

KISSIMMEE, Fla -- September 26, 2019 -- Performing a histological examination of the entire appendix in older adults with suspected appendicitis does not appear to increase the diagnostic yield for neoplasia, and probably doesn’t have to be done routinely, researchers reported here at the 2019 Annual Meeting of the College of American Pathologists (CAP).

In a study that included 118 patients aged 40 years and younger and 71 patients age older than 40 years, only 1 incidental case of sessile serrated adenoma was found (in an older patient).

“For patients aged younger than 40 years who present with appendicitis symptoms, we generally just do histological examinations on the tip of the appendix and the proximal margin, but for people over 40, where there may be a higher suspicion of a neoplasm, we have been routinely examining the entire appendix,” explained Chelsea Marcus, MD, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

While this is done in practice, the utility of doing more than just the tip and margins has not been examined, she said. Therefore, the researchers retrospectively analysed the histopathological data on the 183 patients who underwent appendectomy after a clinical diagnosis of appendicitis.

In 81% of the cases involving younger patients, the pathologist found that the patient had a bout of acute appendicitis, and in 59% of the cases involving older individuals, acute appendicitis was also found.

The second most common diagnosis for the younger patients was an unremarkable appendix (7%), while 13% of older patients were diagnosed by pathologist with interval resolution of appendicitis.

More extensive examination of tissue from older patients has been done to insure there is no hidden neoplasia. However, this is a case where “doing more is doing less,” said Dr. Marcus.

“You just have a lot more tissue that is being examined without really finding anything extraordinary,” she said. “Over-submission of tissue may result in over-utilisation of laboratory resources without significantly improving quality of care.”

[Presentation title: Pathologic Evaluation of Appendectomy Specimens in Patients Older Than 40 Years: Is Submitting the Entire Appendix Indicated? Poster 100]