Comparison of Computed Tomography with Histopathology as Gold Standard for Identification and Prediction of Bowel Thickening and Malignancy

Abstract

Background: Thickness of the bowel wall is a typical finding in patients having abdominal computed tomography scans. It could be a natural variation or the result of neoplastic, inflammatory, viral, or ischemic diseases. While certain radiologic patterns might lead to an accurate diagnosis, yet misidentification can occur.

Objective: To assess the accuracy of computed tomography in identifying bowel wall thickening as a predictor of malignancy, with histopathology serving as the gold standard.

Study Design: Retrospective comparative study.

Place and Duration of Study: Department of Radiology, Shaikh Zayed Hospital, Lahore from 1^st January 2023 to 30^th September 2023.

Methodology: One hundred and ten patients who underwent both abdominal computed tomography scans and subsequent histopathological/colonoscopic assessments of bowel wall samples were included. A proficient radiologist assessed computed tomography abdomen scans for the extent of thickening, and peri-intestinal irregularities like solid organ abnormalities, mesenteric stranding, abscess and sinus tracts, and engorged lymph nodes. Categorical variables were reported as frequencies and percentages. Sensitivity and specificity were also calculated.

Results: There were 70 (63.64%) males and 40 (36.36%) females with mean age of 56.6±16.8 years. The most common clinical indication was abdominal pain, reported by 55 (50%) patients. By CT 58 (52.73%) patients found to have malignancy while by histopathological examination 55 (50%) had malignant lesions. The most prevalent diagnosis was adenocarcinoma of the ascending, transverse, cecum, descending colon, sigmoid, and rectum. The sensitivity, specificity, PPV, NPV and accuracy of CT was 94.55%, 89.09%, 89.66%, 94.23% and 91.82% respectively.

Conclusion: The computed tomography is very useful tool for detecting bowel thickness/malignancy and can be used as an emergency examination modality.

Keywords: Bowel wall thickening, colon, abdominal pain, computed tomography.