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Identification and Quantification of Peritoneal Metastases in Patients With Ovarian Cancer With Multidetector Computed Tomography: Correlation With Surgery and Surgical Outcome
  1. Ur Metser, MD*,
  2. Colin Jones, MD*,
  3. Lindsay M. Jacks, MD,
  4. Marcus Q. Bernardini, MD and
  5. Sarah Ferguson, MD
  1. *Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto;
  2. Department of Biostatistics, Princess Margaret Hospital; and
  3. Department of Gynecologic Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
  1. Address correspondence and reprint requests to Ur Metser, MD, Joint Department of Medical Imaging, Princess Margaret Hospital, 610 University Ave, Suite 3-960 Toronto, Ontario, Canada M5G 2M9. E-mail: ur.metser{at}uhn.on.ca or umetser{at}gmail.com.

Abstract

Purpose: The purpose of the study was to determine the performance of a 64-row multidetector computed tomography (MDCT) in identifying peritoneal metastases in ovarian cancer patients undergoing surgical staging or cytoreduction.

Methods: This retrospective study included 76 patients who underwent surgical staging (n = 11) or cytoreduction (n = 65). Patients had MDCT before surgery (mean, 24 [SD, 16.9] days) as well as correlative surgicopathologic data. For the imaging analysis, the peritoneal cavity was divided to 28 segments, which were assessed for absence or presence of disease. Rate of optimal cytoreduction at the time of surgery was recorded. The standard of reference for this study was surgery, unless there was proof of metastasis as assessed by follow-up imaging. Sensitivity and predictive accuracy of CT and surgery compared with the standard of reference were calculated.

Results: The overall sensitivity and accuracy were 81.2% and 94.3% for MDCT and 87.4% and 97.2% for surgery (P = 0.14, P = 0.007), respectively. There was no difference in the detection of lesions 1 cm or greater between MDCT and surgery (89.3% and 84.9%, respectively; P = 0.31); however, MDCT was less sensitive than surgery in detecting disease sites of less than 1 cm (65.5% and 92.3%, respectively; P = 0.001). For the subgroup of patients undergoing cytoreduction after neoadjuvant chemotherapy (NAC) (n = 30), sensitivities for MDCT and surgery were similar (80% and 76.9%, respectively [P = 0.71]). Although sensitivity of CT was not altered by NAC (P = 0.92), there was a significant decrease in sensitivity of surgical assessment after NAC (94% vs 76.9%; P = 0.003).

Conclusions: Multidetector computed tomography (MDCT) has similar sensitivity as surgery for peritoneal metastases of 1 cm or greater. The maintained sensitivity of MDCT in detecting peritoneal disease after NAC, which is underestimated at surgery, may help surgical planning and may improve optimal cytoreduction rate in this group of patients.

  • Multidetector CT
  • Peritoneal metastases
  • Cytoreduction
  • Neoadjuvant chemotherapy

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Footnotes

  • The authors declare that there are no conflicts of interest.

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