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Original research
Predicting resectable disease in relapsed epithelial ovarian cancer by using whole-body diffusion-weighted MRI
  1. Sander Dumont1,
  2. Vincent Vandecaveye2,3,
  3. Raphaëla Carmen Dresen2,3,
  4. Els Van Nieuwenhuysen4,
  5. Thaïs Baert4,
  6. Frédéric Amant4,5,
  7. Valérie Broeckhoven2 and
  8. Toon Van Gorp4
  1. 1 Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
  2. 2 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
  3. 3 Division of Translational MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
  4. 4 Division of Gynecological Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
  5. 5 Division of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
  1. Correspondence to prof. dr. Toon Van Gorp, Division of Gynecological Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium; toon.vangorp{at}uzleuven.be

Abstract

Objective To determine the diagnostic value of whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) to predict resectable disease at the time of secondary cytoreductive surgery for relapsed epithelial ovarian cancer with a platinum-free interval of at least 6 months.

Methods A retrospective cohort study between January 2012 and December 2021 in a tertiary referral hospital. Inclusion criteria were: (a) first recurrence of epithelial ovarian cancer; (b) platinum-free interval of ≥6 months; (c) intent to perform secondary cytoreductive surgery with complete macroscopic resection; and (d) WB-DWI/MRI was performed.

Diagnostic tests of WB-DWI/MRI for predicting complete resection during secondary cytoreductive surgery are calculated as well as the progression-free and overall survival of the patients with a WB-DWI/MRI scan that showed resectable disease or not.

Results In total, 238 patients could be identified, of whom 123 (51.7%) underwent secondary cytoreductive surgery. WB-DWI/MRI predicted resectable disease with a sensitivity of 93.6% (95% confidence interval [CI] 87.3% to 96.9%), specificity of 93.0% (95% CI 87.3% to 96.3%), and an accuracy of 93.3% (95% CI 89.3% to 96.1%). The positive predictive value was 91.9% (95% CI 85.3% to 95.7%).

Prediction of resectable disease by WB-DWI/MRI correlated with improved progression-free survival (median 19 months vs 9 months; hazard ratio [HR] for progression 0.36; 95% CI 0.26 to 0.50) and overall survival (median 75 months vs 28 months; HR for death 0.33; 95% CI 0.23 to 0.47).

Conclusion WB-DWI/MRI accurately predicts resectable disease in patients with a platinum-free interval of ≥6 months at the time of secondary cytoreductive surgery and could be of complementary value to the currently used models.

  • Genital Neoplasms, Female
  • Ovarian Cancer
  • Ovarian Neoplasms
  • Surgery

Data availability statement

Data are available upon reasonable request. Upon request, we will provide our data for independent analysis for the purposes of additional data analysis or for the reproducibility of this study.

https://doi.org/10.1136/ijgc-2023-004592

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    Data availability statement

    Data are available upon reasonable request. Upon request, we will provide our data for independent analysis for the purposes of additional data analysis or for the reproducibility of this study.

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    Footnotes

    • ECOG: Eastern Cooperative Oncology Group / IQR: Interquartile range / SD: Standard deviation CI: Confidence interval / WB-DWI/MRI: Whole-body diffusion-weighted MRI

    • Contributors SD: Conceptualization, methodology, formal analysis, investigation, writing - original draft, writing - review and editing, visualization; VV, RCB: conceptualization, methodology, formal analysis, investigation, resources, writing - original draft, writing - review and editing, visualization; EVN, TB, FA, VB: resources, writing - review and editing; TVG: guarantor, conceptualization, methodology, formal analysis, investigation, resources, writing - original draft, writing - review and editing, supervision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.