Surgeon-performed ultrasound recommended for appendicitis imaging

Surgeon-performed ultrasound should be the first imaging technique used to diagnose patients with suspected appendicitis.

That’s according to German researchers who analyzed 53 peer-reviewed articles published between 2010 and 2016. Their aim in reviewing the literature was to develop an ultrasound-based protocol that would simplify the choice between ordering more imaging or going straight to surgery after imaging with just ultrasound.

“The relevance of ultrasound in diagnosing acute appendicitis is controversial,” Christian Beltzer, MD, and colleagues at the University of Ulm write in introducing their findings. “The validity of ultrasound for this indication as compared with CT and MRI is unclear, they note, “as is the difference between surgeon-performed ultrasound and radiologist-performed ultrasound.”

The researchers used the U.S. National Library of Medicine’s PubMed to identify relevant studies, according to the study abstract.

They found that ultrasound has become well established in protocols for diagnosing acute appendicitis and, in fact, has already replaced CT as the imaging technique of choice.

Other key findings:

  • The differences between surgeon-performed ultrasound and radiologist-performed ultrasound with regard to sensitivity, specificity and positive and negative predictive values are not statistically significant.
  • The main benefit of having surgeons rather than radiologists perform the ultrasound is the simultaneous clinical assessment of the patient via palpation by the surgeon while the sonogram is performed, which can increase diagnostic accuracy even further.
  • Radiation exposure as a result of CT could be avoided or significantly reduced through the routine use of ultrasound, which is increasingly being used and is widely available.

Hence their recommendation of a “structured diagnostic approach with obligatory use of surgeon-performed ultrasound” for diagnosing appendicitis-likely patients.

“Additional diagnosis using CT or MRI is only recommended if sonographic imaging of the appendix is impossible in combination with specific clinical and laboratory criteria,” Beltzer et al. write.

The study is running in the August edition of the German surgery journal Zentralblatt für Chirurgie.