Diagnostic Accuracy of Ultrasound in Acute Cholecystitis using Intraoperative Findings as Gold Standard
Abstract
Objective: Right upper quadrant pain is a common complaint among patients presenting to both emergency and outpatient department and is frequently diagnosed as acute cholecystitis. Ultrasonography is the first-line preferred diagnostic tool used for its evaluation. Several previous studies have assessed the accuracy of ultrasound in diagnosing acute cholecystitis; However, methodological variations limit their generalizability. This study aimed to determine the diagnostic accuracy of ultrasound for acute cholecystitis using intraoperative findings as the gold standard in our healthcare setting. Methods: This prospective diagnostic accuracy study was conducted at the IIMC-T Pakistan Railway General Hospital, Rawalpindi. A total of 150 patients with right upper quadrant pain were enrolled. All participants had ultrasound by a trained radiologist, followed by laparoscopic cholecystectomy. Intraoperative findings were considered the gold standard for diagnosis. The diagnostic accuracy of ultrasound was determined, including sensitivity, specificity, PPV, NPV, and LR+ and LR-. Results: A total of 150 patients with a mean age of 45.15 ± 12.24 years, the majority of whom were females (76.7%), were analyzed. The diagnostic accuracy of ultrasound for acute showed a sensitivity of 34.38% (95% CI: 25.64 - 44.31), specificity of 77.78% (95% CI: 65.06 - 86.8), PPV of 73.33% (95% CI: 58.96 – 84.04), and NPV of 40% (95% CI: 31.14 – 49.56). The overall diagnostic accuracy was 50%(41.75- 58.25%). Conclusion: Ultrasound findings, such as thickness of gall bladder wall and pericholecystic fluid, revealed limited sensitivity and a high false-negative rate compared to intraoperative findings. Therefore, from a clinical standpoint, it should always be supplemented with more sensitive indicators and further imaging modalities to avoid overlooking true cases. Keywords: Cholecystitis, Acute, Ultrasonography, Diagnostic Imaging, Sensitivity and Specificity, Cholecystectomy, Laparoscopic, Intraoperative Period