Introduction/Background It is essential to perform a detailed preoperative description of disease’s extension which can improve patient management, including preoperative work-up, operative time and postoperative care. Ultrasound (US) is a reliable method for differentiation between benign and malignant adnexal tumors and for local staging of endometrial and cervical cancers. Few studies have pointed the use of US evaluating the extent of disease in advanced ovarian cancer and evaluation of operability. The objective of this study is to asses the accuracy of US predicting rectosigmoid tumor infiltration in patients with advanced ovarian cancer.
Methodology This observational prospective study includes 55 patients with an US diagnosis of adnexal mass suspected of malignancy which was confirmed histologically. 39 patients underwent primary surgery and 16 interval surgery. US was performed to assess disease’s extension. Rectosigmoid infiltration was evaluated by perioperative findings.
Results Rectosigmoid infiltration was confirmed in 36 patients. Rectosigmoid resection was performed in 12 cases and visceral peritoneum stripping in 3. In the other 21 cases bowel surgery was not performed due to unresectable disease. Rectosigmoid carcinomatosis was correctly detected by US in 24/36 patients. In 9/36 it was not detected and in 3/36 rectosigmoid wall was not assessable. In 2/24 cases miliary carcinomatosis was identified and 22/24 had nodular carcinomatosis with a nodule mean diametre of 26 mm. In 23/24 there was a douglas lock.The Sensitivity of US in detecting rectosigmoid carcinomatosis was 72.7%, and specificity was 93.7%. Positive predictive value of 96% and negative predictive value of 62.5%.The absence of ascites, high BMI, dimensions of adnexal mass and abundant bowel content could affect the accuracy of US.
Conclusion US is an accurate method for the pre-operative assessment of rectosigmoid infiltration in advanced ovarian cancer and it can be used for adequately preoperative planning and predict need of surgery on rectosigmoid carcinomatosis.
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