{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T14:13:19Z","timestamp":1781619199245,"version":"3.54.5"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Occult appendiceal tumors may present as acute appendicitis, hindering preoperative recognition. Existing clinical and imaging criteria remain nonspecific. This study aimed to identify practical preoperative predictors by integrating hematologic indices with CT morphometry in a matched case\u2013control design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective matched case\u2013control study, 2,599 adult appendectomy cases (2020\u20132024) were screened. Sixty-two had histologically confirmed neoplasms; after excluding incomplete records, 40 malignant cases were matched 1:4 by age and sex with 160 benign controls. Preoperative lymphocyte-to-monocyte ratio (LMR) and CT-measured appendix diameter were analyzed using conditional logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After matching (SMD\u2009&lt;\u20090.01), malignant cases showed higher LMR (3.41\u2009\u00b1\u20091.89 vs. 2.51\u2009\u00b1\u20091.31,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and larger diameter (12.6\u2009\u00b1\u20094.1\u00a0mm vs. 10.8\u2009\u00b1\u20092.7\u00a0mm,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). LMR\u2009&gt; 3.8 increased malignancy risk 3.77-fold, diameter\u2009&gt; 14\u00a0mm increased it 4.9-fold, and both combined raised risk nearly 18-fold (AUC\u2009=\u20090.74; Hosmer\u2013Lemeshow\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.09).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Elevated LMR and enlarged appendix diameter independently predict occult appendiceal neoplasms. Patients exceeding both thresholds may benefit from intraoperative frozen-section or extended resection. Multicenter validation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12893-025-03328-3","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T14:05:36Z","timestamp":1763733936000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative lymphocyte-to-monocyte ratio and CT-measured appendix diameter in occult appendiceal neoplasms: a matched case\u2013control analysis"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2032-0904","authenticated-orcid":false,"given":"Yusuf Yunus","family":"Korkmaz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7163-4248","authenticated-orcid":false,"given":"Mehmet \u015eaban","family":"Korkmaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1323-4511","authenticated-orcid":false,"given":"Ay\u015fe Nur Balc\u0131","family":"Yapalak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3830-7086","authenticated-orcid":false,"given":"O\u011fuzhan","family":"Ayd\u0131n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4066-6072","authenticated-orcid":false,"given":"Feyyaz","family":"G\u00fcng\u00f6r","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1319-9114","authenticated-orcid":false,"given":"\u0130lyas","family":"Kuda\u015f","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0380-7585","authenticated-orcid":false,"given":"Erdem","family":"K\u0131nac\u0131","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"3328_CR1","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-024-02412-4","author":"E Dohner","year":"2024","unstructured":"Dohner E, Kierdorf FJ, Langer R, Zuber M, Fahrner R. Retrospective analysis of the incidence of appendiceal neoplasm and malignancy in patients treated for suspected acute appendicitis. BMC Surg. 2024. https:\/\/doi.org\/10.1186\/s12893-024-02412-4.","journal-title":"BMC Surg"},{"key":"3328_CR2","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-023-02183-4","author":"RE N\u00fa\u00f1ez-Rocha","year":"2023","unstructured":"N\u00fa\u00f1ez-Rocha RE, Gir\u00f3n F, Rodr\u00edguez L, Camargo-G\u00f3mez D, Restrepo-Bonilla C, L\u00f3pez R, Cadena M, Nassar R, Herrera-Almario G, Hern\u00e1ndez-Restrepo JD. Incidence of appendiceal neoplasms in appendectomy patients. BMC Surg. 2023. https:\/\/doi.org\/10.1186\/s12893-023-02183-4.","journal-title":"BMC Surg"},{"key":"3328_CR3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0294153","author":"D Wang","year":"2023","unstructured":"Wang D, Ge H, Lu Y, Gong XY. 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Surgeon. 2021. https:\/\/doi.org\/10.1016\/j.surge.2021.01.010.","journal-title":"Surgeon"},{"key":"3328_CR8","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-017-0122-9","author":"F Teixeira","year":"2017","unstructured":"Teixeira F, Netto SD, do C, Akaishi EH, Utiyama EM, Menegozzo CAM, Rocha MC. Acute appendicitis, inflammatory appendiceal mass and the risk of a hidden malignant tumor: a systematic review of the literature. World J Emerg Surg. 2017. https:\/\/doi.org\/10.1186\/s13017-017-0122-9.","journal-title":"World J Emerg Surg"},{"key":"3328_CR9","doi-asserted-by":"publisher","DOI":"10.14744\/tjtes.2023.34833","author":"MA Ko\u00e7","year":"2023","unstructured":"Ko\u00e7 MA, \u00c7elik SU. Evaluation of factors predicting appendiceal tumoral lesions in patients undergoing appendectomy for acute appendicitis. 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In accordance with national regulations and the retrospective design of the study, the requirement for informed consent to participate was waived by the Clinical Research Ethics Committee of Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital. Clinical trial number: not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable. (No identifiable images or personal data of participants are included.)","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"563"}}