Mehmet Şaban Korkmaz

Background and Objectives: Incidental gallbladder carcinoma (IGBC) is an uncommon but clinically significant finding after elective cholecystectomy, as failure to recognize malignancy preoperatively may lead to inadequate initial surgical management. Inflammation-based hematological indices have been explored in various gastrointestinal malignancies; however, data focusing on preoperative discrimination of IGBC are limited. This study aimed to evaluate the diagnostic performance of the Advanced Lung Cancer Inflammation Index (ALI) and other inflammatory and immunonutritional indices in distinguishing IGBC from benign gallbladder disease. Materials and Methods: This retrospective matched case–control study included patients who underwent elective cholecystectomy between 2020 and 2025. Nineteen patients with histopathologically confirmed IGBC were matched 1:4 by age and sex with 76 patients with benign gallbladder disease. Preoperative laboratory parameters obtained within 72 h before surgery were used to calculate inflammatory indices, including NLR, PLR, LMR, SII, CAR, ALI, and the CALLY index. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis. Independent associations with malignancy were evaluated using matched conditional logistic regression. Results: No significant differences were observed between benign and malignant groups in baseline demographic or routine laboratory parameters. Among derived indices, ALI and LMR demonstrated borderline differences, representing the closest discriminatory markers. In ROC analysis, ALI showed the highest diagnostic performance (AUC = 0.69), followed by LMR (AUC = 0.639). In matched conditional logistic regression, ALI was independently and inversely associated with malignancy (adjusted OR = 0.997 per unit, 95% CI: 0.9937–1.0000; p = 0.04); when rescaled per 100-unit increase, the adjusted OR was 0.93, whereas LMR did not reach statistical significance. Conclusions: Among evaluated preoperative inflammatory and immunonutritional indices, ALI demonstrated a more consistent association with incidental gallbladder carcinoma. Although its discriminative ability was moderate, ALI may serve as a complementary biomarker for preoperative risk stratification when integrated with clinical and radiological assessment.

Introduction: 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–control design. Methods: In this retrospective matched case–control study, 2,599 adult appendectomy cases (2020–2024) 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. Results: After matching (SMD < 0.01), malignant cases showed higher LMR (3.41 ± 1.89 vs. 2.51 ± 1.31, p = 0.001) and larger diameter (12.6 ± 4.1 mm vs. 10.8 ± 2.7 mm, p = 0.001). LMR > 3.8 increased malignancy risk 3.77-fold, diameter > 14 mm increased it 4.9-fold, and both combined raised risk nearly 18-fold (AUC = 0.74; Hosmer–Lemeshow p = 0.09). Conclusions: 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.

Purpose: Intussusception is a rare cause of intestinal obstruction in adults and often poses a diagnostic challenge due to its nonspecific symptoms. This study aimed to identify clinical and radiological predictors that guide the need for surgical intervention in adult intussusception cases. Methods: We retrospectively reviewed adult patients diagnosed with intussusception via abdominal CT or MRI between June 2020 and January 2025. Demographic, clinical, imaging, surgical, and pathological data were analyzed. Statistical comparisons were made between operated and non-operated patients, and ROC curve analysis was performed to assess the predictive value of bowel diameter. Results: A total of 40 adult patients were included (mean age: 43.9 years; 50% female). Surgical intervention was required in 47.5% (n = 19) of cases. Symptom presence (p = 0.032), ileus development (p = 0.0246), and increased bowel diameter (mean 49.3 mm vs. 35.0 mm, p = 0.005) were significantly associated with surgery. The ROC analysis showed that a bowel diameter ≥ 34.0 mm predicted surgical need with 100% sensitivity and 61.9% specificity (AUC = 0.854). Malignant pathology was more common in colonic intussusceptions (70%, p = 0.023), and a bowel diameter ≥ 41.0 mm was associated with malignancy (AUC = 0.678). Conclusion: Clinical presentation, presence of ileus, and bowel diameter are key indicators for surgical decision-making in adult intussusception. A bowel diameter of ≥ 34 mm should prompt consideration for surgical intervention, while ≥ 41 mm suggests a higher probability of malignancy, especially in colonic involvement.