{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T04:36:47Z","timestamp":1778560607903,"version":"3.51.4"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T00:00:00Z","timestamp":1689897600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Mucosal appendicitis is defined by neutrophilic infiltration limited to the mucosa, with no transmural invasion; it is currently a controversial entity. The aim of our study was to determine whether mucosal appendicitis represents an early stage of acute appendicitis (AA) or should be considered a negative appendectomy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective study was performed of children with suspected AA who underwent surgical treatment between 2017 and 2020. The participants were divided into 2 groups according to histologic appendiceal findings: mucosal appendicitis (MA) and negative appendicitis (NA). Demographic, clinical, ultrasound, and laboratory features were compared between the groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 1269 patients with suspected appendicitis in whom appendectomy was performed were included, with a median age of 10.5 years. Mucosal appendiceal inflammation was histologically confirmed in 30 cases (MA group), while no inflammation or other pathologic findings were observed in 25 cases (NA group), with no differences in demographic, clinical, or ultrasound features between the groups. Those in the MA group presented with significantly higher leukocyte and neutrophil counts and higher neutrophil to lymphocyte ratios (NLRs) than those in the NA group (P\u2009&amp;lt;\u2009.001). The NLR was the parameter with the highest area under the curve (0.736) for the diagnosis of MA. A cutoff of 3.20 was established, with a maximum sensitivity and specificity of 62.5% and 78.9%, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Mucosal appendicitis presents with laboratory and histologic inflammatory features that can be distinguished from nonappendicitis and should therefore be considered a pathologic entity within the spectrum of AA. Preoperative leukocyte and neutrophil counts and NLRs may help reduce the number of negative appendectomies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajcp\/aqad079","type":"journal-article","created":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T13:27:11Z","timestamp":1689946031000},"page":"500-506","source":"Crossref","is-referenced-by-count":1,"title":["Mucosal appendicitis: How can it be differentiated from nonappendicitis?"],"prefix":"10.1093","volume":"160","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4994-6898","authenticated-orcid":false,"given":"Carlos","family":"Delgado-Miguel","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Prisma Health Children\u2019s Hospital , Columbia, SC , US"},{"name":"Department of Pediatric Surgery, La Paz Children\u2019s Hospital , Madrid , Spain"},{"name":"Institute for Biomedical Research La Paz (IdiPaz), La Paz University Hospital , Madrid , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Miguel-Ferrero","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, La Paz Children\u2019s Hospital , Madrid , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bonifacio","family":"Delgado","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Complutense University of Madrid , Madrid , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guillermo","family":"Escuer Albero","sequence":"additional","affiliation":[{"name":"Department of Pathology, La Paz University Hospital , Madrid , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Camps","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Prisma Health Children\u2019s Hospital , Columbia, SC , US"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"L\u00f3pez-Santamar\u00eda","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, La Paz Children\u2019s Hospital , Madrid , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Hern\u00e1ndez Oliveros","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, La Paz Children\u2019s Hospital , Madrid , Spain"},{"name":"Department of Mathematics, Complutense University of Madrid , Madrid , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,7,21]]},"reference":[{"issue":"4","key":"2023110715000438900_CIT0001","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1001\/jamasurg.2019.6031","article-title":"Acute appendicitis incidence-predisposing factors, from microbiota to socioeconomic status","volume":"155","author":"Salminen","year":"2020","journal-title":"JAMA Surg"},{"issue":"5","key":"2023110715000438900_CIT0002","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/S0196-0644(86)80993-3","article-title":"A practical score for the early diagnosis of acute appendicitis","volume":"15","author":"Alvarado","year":"1986","journal-title":"Ann Emerg Med."},{"issue":"6","key":"2023110715000438900_CIT0003","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.jpedsurg.2016.02.055","article-title":"Diagnostic imaging practices for children with suspected appendicitis evaluated at definitive care hospitals and their associated referral centers","volume":"51","author":"Glass","year":"2016","journal-title":"J Pediatr Surg."},{"issue":"1","key":"2023110715000438900_CIT0004","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1002\/bjs.4464","article-title":"Meta-analysis of the clinical and laboratory diagnosis of appendicitis","volume":"91","author":"Andersson","year":"2004","journal-title":"Br J Surg."},{"issue":"4","key":"2023110715000438900_CIT0005","doi-asserted-by":"crossref","first-page":"E284eE","DOI":"10.1111\/ans.13820","article-title":"Dilemma of mucosal appendicitis: a clinicopathological entity? A retrospective cohort study","volume":"88","author":"Mizumoto","year":"2018","journal-title":"ANZ J Surg"},{"key":"2023110715000438900_CIT0006","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jss.2019.04.039","article-title":"Clinical and imaging correlates of pediatric mucosal appendicitis","volume":"242","author":"Gee","year":"2019","journal-title":"J Surg Res."},{"issue":"3","key":"2023110715000438900_CIT0007","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/00000658-198303000-00019","article-title":"Clinical significance of mucosal inflammation of the vermiform appendix","volume":"197","author":"Pieper","year":"1983","journal-title":"Ann Surg."},{"issue":"10000","key":"2023110715000438900_CIT0008","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1016\/S0140-6736(15)00275-5","article-title":"Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management","volume":"386","author":"Bhangu","year":"2015","journal-title":"Lancet."},{"issue":"4","key":"2023110715000438900_CIT0009","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1002\/bimj.200410135","article-title":"Estimation of the Youden Index and its associated cutoff point","volume":"47","author":"Fluss","year":"2005","journal-title":"Biom J."},{"issue":"1","key":"2023110715000438900_CIT0010","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/S1092-9134(00)90011-X","article-title":"The pathology of acute appendicitis","volume":"4","author":"Carr","year":"2000","journal-title":"Ann Diagn Pathol."},{"issue":"2","key":"2023110715000438900_CIT0011","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.mpdhp.2007.12.002","article-title":"Beyond acute inflammation: a review of appendicitis and infections of the appendix","volume":"14","author":"Lamps","year":"2008","journal-title":"Diagn Histopathol"},{"key":"2023110715000438900_CIT0012","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.amsu.2020.09.003","article-title":"Best evidence topic: can acute appendicitis manifest with normal inflammatory markers","volume":"58","author":"Ibrahim","year":"2020","journal-title":"Ann Med Surg (Lond)"},{"key":"2023110715000438900_CIT0013","doi-asserted-by":"crossref","first-page":"6508619","DOI":"10.1155\/2016\/6508619","article-title":"Diagnostic value of white blood cell and C-reactive protein in pediatric appendicitis","volume":"2016","author":"Buyukbese Sarsu","year":"2016","journal-title":"Biomed Res Int."},{"issue":"4","key":"2023110715000438900_CIT0014","first-page":"185","article-title":"Neutrophil-to-lymphocyte ratio as a predictor of peritonitis in acute appendicitis in children. Article in Spanish","volume":"32","author":"Delgado-Miguel","year":"2019","journal-title":"Cir Pediatr."},{"key":"2023110715000438900_CIT0015","doi-asserted-by":"crossref","first-page":"424","DOI":"10.3389\/fped.2019.00424","article-title":"Neutrophil-to-lymphocyte ratio as a predictor of postsurgical intraabdominal abscess in children operated for acute appendicitis","volume":"7","author":"Delgado-Miguel","year":"2019","journal-title":"Front Pediatr."},{"issue":"9","key":"2023110715000438900_CIT0016","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.1016\/j.jpedsurg.2018.10.106","article-title":"The impact of pathological criteria on pediatric negative appendectomy rate","volume":"54","author":"Maloney","year":"2019","journal-title":"J Pediatr Surg."}],"container-title":["American Journal of Clinical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajcp\/article-pdf\/160\/5\/500\/52783520\/aqad079.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajcp\/article-pdf\/160\/5\/500\/52783520\/aqad079.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T19:09:08Z","timestamp":1699384148000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajcp\/article\/160\/5\/500\/7227539"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,21]]},"references-count":16,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,7,21]]},"published-print":{"date-parts":[[2023,11,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ajcp\/aqad079","relation":{},"ISSN":["0002-9173","1943-7722"],"issn-type":[{"value":"0002-9173","type":"print"},{"value":"1943-7722","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,11,1]]},"published":{"date-parts":[[2023,7,21]]}}}