Article Text
Abstract
Introduction/Background*The extent of peritoneal spread in advanced ovarian cancer (AOC) heavily impacts on the chance of a complete surgical cytoreduction. The decision-making process on the feasibility of cytoreductive surgery should include a dedicated imaging evaluation. The aim of this study was to prospectively compare a radiologic Peritoneal Cancer Index (rPCI) with the surgical PCI (sPCI).
Methodology 128 consecutive AOC patients planned for cytoreductive surgery underwent preoperative contrast-enhanced Computed Tomography (CT) scan to calculate the rPCI, then the sPCI was determined intraoperatively. CT scans were performed by two dedicated radiologists, and re-evaluated by a third. The rPCI correlation with sPCI was calculated by Lin’s Concordance Correlation Coefficient (CCC), and represented by Bland-Altman agreement plot and Passing-Bablok regression line.
Result(s)*Primary debulking surgery (PDS), and interval debulking surgery (IDS) were performed in 88 and 40 patients, respectively (complete cytoreduction in 56.8% PDS and 67.5% IDS). Overall, mean±SD rPCI was 16.2±6.4 (95%CI:15.1-17.3) and sPCI 14.7±6.9 (95%CI:13.5-15.9), showing a moderate correlation between preoperative CT scan and surgical findings (figures 1-2, CCC=0.64). The best concordance was reported for PDS vs. IDS (CCC=0.64 vs. 0.60) and in middle-high abdominal vs. low quadrants (CCC=0.57 vs. 0.40), while rPCI overestimated ileo-jejunal spread (CCC=0.21).
Conclusion*CT is moderately accurate in predicting the sPCI in AOC patients. The rPCI scoring seems to be helpful and should be part of the decision-making process on surgical cytoreduction.