Article Text

Download PDFPDF
778 Predictive value of whole-body diffusion-weighted MRI in the preoperative assessment of advanced ovarian cancer after neo-adjuvant chemotherapy
  1. Vincent Vandecaveye1,
  2. Raphaëla Carmen Dresen1,
  3. Valerie Broeckhoven1,
  4. Thaïs Baert2,
  5. Els Van Nieuwenhuysen3,
  6. Frederik Dekezyer1,
  7. Toon Van Gorp4 and
  8. Ignace Vergote5
  1. 1Radiology, University Hospitals Leuven, Leuven, Belgium
  2. 2Division of Gynecologic Oncology; Department of Obstetrics and Gynecology, KU Leuven University Hospitals Leuven, Leuven, Belgium
  3. 3UZ Leuven, Leuven, Belgium
  4. 4University Hospital Leuven Leuven Cancer Institute, Leuven, Belgium
  5. 5Division of Gynaecological Oncology, UZ Leuven, KU Leuven, Leuven, Belgium


Introduction/Background Predicting surgical outcome after neoadjuvant chemotherapy (NACT) for advanced ovarian cancer remains challenging. We aimed to evaluate whole body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) after NACT to predict resectability at interval debulking surgery (IDS) and survival.

Methodology In the framework of a prospective single-centre clinical trial (NCT01657747), 105 patients undergoing NACT for non-primary resectable Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) stage IIIC/IV ovarian cancer underwent WB-DWI/MRI prior to IDS from May 2011 to May 2015. The diagnostic value of WB-DWI/MRI using institutional operability criteria was analysed for predicting complete resection, progression-free (PFS) and overall survival (OS). Surgical exploration, biopsies of metastases beyond surgical reach and imaging follow-up served as reference standard.

Results IDS achieved complete resection in 78 of 105 patients (74%). Median PFS was 15 months; median OS was 33 months. WB-DWI/MRI predicted complete resection with 97.4% (95% confidence interval [CI] 91.0%-99.7%) sensitivity, 81.5% (CI 95% 61.9%-93.7%) specificity and 93.3% (CI 95% 86.7%-97.3%) accuracy. Prediction of complete resection by WB-DWI/MRI correlated with improved PFS (median 18 versus 7 months) and OS (median 45 months versus 20 months); similar as complete resection at IDS (PFS: median 18 versus 7 months; OS: median 41 versus 21 months).

MRI prediction of (in)complete resection, preoperative absolute CA-125 value and (in)complete resection status at IDS showed significant effects on PFS (MRI: Hazard ratio (HR) = 5.43, p<0.01; CA-125: HR = 1.00, p<0.001; IDS: HR = 4.19, p<0.001) and OS (MRI: HR = 4.24, p<0.01; CA-125: HR = 1.00, p<0.001; IDS: HR = 2.87, p<0.001). After multivariable analysis, MRI prediction of complete resection and preoperative CA-125 remained significant (both p<0.001).

Conclusion WB-DWI/MRI accurately predicts complete resection at IDS for FIGO stage IIIC/IV ovarian cancer. MRI prediction of complete resection was an independent predictor of PFS and OS and a stronger predictive factor than complete resection at IDS.

Disclosures Presenter: No (financial) conflict of interest to disclose.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.