Evaluation of the Diagnostic Performance of Abdominal Ultrasonography in Acute Appendicitis: A Comparison with the Alvarado Clinical Score and Histopathological Findings

Kachoei, A; Daneshmand Zandabadi, F; Madani, S; Savaddar, F; Eshraghi, M; Vahedian, M; Kord Afshar, E; Rahmani, F

doi:10.22034/ijs.2026.741448

Evaluation of the Diagnostic Performance of Abdominal Ultrasonography in Acute Appendicitis: A Comparison with the Alvarado Clinical Score and Histopathological Findings

Articles in Press

Authors

A Kachoei ¹

F Daneshmand Zandabadi ²

S Madani ³

F Savaddar ⁴

M Eshraghi ⁵

M Vahedian ⁶

E Kord Afshar ⁷

F Rahmani ⁸

¹ Associate Professor, Department of General Surgery, School of Medicine, Qom University of Medical Sciences, Shahid Beheshti Educational and Medical Center, Qom, Iran

² General Practitioner, Department of Surgery, School of Medicine, Qom University of Medical Sciences, Shahid Beheshti Educational and Medical Center, Qom, Iran

³ Assistant Professor, Department of General and Minimally Invasive Surgery, School of Medicine, Qom University of Medical Sciences, Shahid Beheshti Educational and Medical Center, Qom, Iran

⁴ Assistant Professor, Department of Plastic and Reconstructive Surgery, School of Medicine, Qom University of Medical Sciences, Shahid Beheshti Educational and Medical Center, Qom, Iran

⁵ Associate Professor, Department of Thoracic Surgery, Faculty of Medicine, Qom University of Medical Sciences, Shahid Beheshti Hospital

⁶ Associate Professor of Epidemiology, Department of Community and Family Medicine, School of Medicine, Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran

⁷ Assistant Professor of Radiology, Department of Radiology, School of Medicine, Alborz University of Medical Sciences, Imam Ali Educational and Medical Center, Karaj, Iran

⁸ Radiology Resident, Department of Radiology, School of Medicine, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Tehran, Iran

https://doi.org/10.22034/ijs.2026.741448

Abstract

Background and Objective: Acute appendicitis is one of the most common causes of acute abdomen, and accurate diagnosis plays a crucial role in reducing negative appendectomy rates and disease-related complications. This study aimed to compare the diagnostic performance of abdominal ultrasonography and the Alvarado scoring system with histopathological findings in patients suspected of having acute appendicitis.
Methods: In this cross-sectional study, 117 patients with suspected acute appendicitis who underwent appendectomy were enrolled. Demographic characteristics, clinical findings, laboratory results, ultrasonographic findings, and Alvarado scores were collected and compared with histopathological findings, which served as the reference standard.
Results: Of the 117 patients, 75 (64.1%) had histopathologically confirmed acute appendicitis, while 42 (35.9%) had negative appendectomy. Abdominal ultrasonography demonstrated a sensitivity of 40%, specificity of 69%, and an overall diagnostic accuracy of 50.4%. Both the mean white blood cell (WBC) count and the mean Alvarado score were significantly higher in patients with confirmed acute appendicitis than in those without appendicitis (P < 0.05).
Conclusion: Abdominal ultrasonography alone demonstrates insufficient sensitivity for the definitive diagnosis of acute appendicitis. However, combining ultrasonography with the Alvarado scoring system, clinical assessment, and laboratory findings significantly enhances diagnostic accuracy and facilitate more informed clinical decision-making.

Keywords

Appendicitis

Ultrasonography

Pathology

Appendectomy

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