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Correlation of surgeon radiology assessment with laparoscopic disease site scoring in patients with advanced ovarian cancer
  1. Nicole D Fleming1,
  2. Shannon N Westin1,
  3. Larissa A Meyer1,
  4. Aaron Shafer1,
  5. Jose Alejandro Rauh-Hain1,
  6. Michaela Onstad1,
  7. Lauren Cobb1,
  8. Michael Bevers1,
  9. Bryan M Fellman2,
  10. Jennifer Burzawa3,
  11. Priya Bhosale4,
  12. Behrouz Zand1,
  13. Amir Jazaeri1,
  14. Charles Levenback1,
  15. Robert L Coleman1,
  16. Pamela T Soliman1 and
  17. Anil K Sood1
  1. 1Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
  4. 4Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Nicole D Fleming, Department of Gynecologic Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA; nfleming{at}mdanderson.org

Abstract

Objective Radiographic triage measures in patients with new advanced ovarian cancer have yielded inconsistent results.

Objective To determine the correlation between surgeon radiology assessment and laparoscopic scoring by disease sites in patients with newly diagnosed advanced stage ovarian cancer.

Methods Fourteen gynecologic oncology surgeons from a single institution performed a blinded review of pre-operative contrast-enhanced CT imaging from patients with advanced stage ovarian cancer. Each of the patients had also undergone laparoscopic scoring assessment, between April 2013 and December 2017, to determine primary resectability using the validated Fagotti scoring method, and assigned a predictive index value score. Surgeons were asked to provide expected predictive index value scores based on their blinded review of the antecedent CT imaging. Linear mixed models were conducted to calculate the correlation between radiologic and laparoscopic score for surgeons individually, and as a group. Once the model was fit, the inter-class correlation and 95% CI were calculated.

Results Radiology review was performed on 20 patients with advanced stage ovarian cancer who underwent laparoscopic scoring assessment. Surgeon faculty rank included assistant professor (n=5), associate professor (p=4), and professor (n=5). The kappa inter-rater agreement was −0.017 (95% CI −0.023 to −0.005), indicating low inter-rater agreement between radiology review and actual laparoscopic score. The inter-class correlation in this model was 0.06 (0.02–0.21), indicating that surgeons do not score the same across all the images. When using a clinical cut-off point for the predictive index value of 8, the probability of agreement between radiology and actual laparoscopic score was 0.56 (95% CI 0.49 to 0.73). Examination of disease site sub-scales showed that the probability of agreement was as follows: peritoneum 0.57 (95% CI 0.51 to 0.62), diaphragm 0.54 (95% CI 0.48 to 0.60), mesentery 0.51 (95% CI 0.45 to 0.57), omentum 0.61 (95% CI 0.55 to 0.67), bowel 0.54 (95% CI 0.44 to 0.64), stomach 0.71 (95% CI 0.65 to 0.76), and liver 0.36 (95% CI 0.31 to 0.42). The number of laparoscopic scoring cases, tumor reductive surgery cases, or faculty rank was not significantly associated with overall or sub-scale agreement.

Conclusions Surgeon radiology review did not correlate highly with actual laparoscopic scoring assessment findings in patients with advanced stage ovarian cancer. Our study highlights the limited accuracy of surgeon radiographic assessment to determine resectability.

  • ovarian cancer
  • laparoscopes
  • cytoreduction surgical procedures
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Footnotes

  • Twitter @nicoleflemingmd, @Shannon.Westin, @aaronshafer99, @maonstad, @rcoledude, @PamSolimanMD

  • Contributors All authors contributed to writing and editing the manuscript. All authors read and approved the final manuscript.

  • Funding This research was in part supported by the MD Anderson Ovarian Cancer Moon Shot and by the National Institutes of Health through MD Anderson’s Cancer Center support grant (P30CA016672; used the Clinical Trials Support Resource and the Biostatistics Resource Group), T32 training grant for gynecologic oncologists (T32CA101642), and Ovarian Cancer SPORE funding (CA217685), The National Institute of Health’s National Cancer Institute grants K08CA234333 and K07CA201013, the Andrew Sabin Family Fellowship, the GOG Foundation scholar investigator award, the Frank McGraw Memorial Chair in Cancer Research, and the American Cancer Society research professor award.

  • Competing interests The authors have the following conflicts of interest to disclosure. Relevant financial activities outside the supported work; NDF: consultant/advisory board (Tesaro, BMS/Pfizer); SNW: consultant (AstraZeneca, Clovis Oncology, GSK/Tesaro, Novartis, Roche/Genentech, Eisai, Merck, Pfizer, Circulogene), research funding (ArQule, AstraZeneca, Clovis Oncology, GSK/Tesaro, Novartis, Roche/Genentech, Bayer, Cotinga Pharmaceuticals); LAM: research funding (AstraZeneca); AJ: consultant (Gerson and Lehrman Group, Guidepoint, Iovance, Nuprobe, Simcere, Pact Pharma), research funding (AstraZeneca, BMS, Iovance, Aravive, Pfizer, Immatics USA, Eli Lilly); RLC: consultant (AstraZeneca, Clovis Oncology, GSK/Tesaro, Novartis, Roche/Genentech, Eisai, Merck, Pfizer, Novocure, Genmab, Gamamab, Oncosec, Tarveda), research funding (AbbVie, Genmab, Merck, AstraZeneca, Clovis Oncology, Roche/Genentech); AKS: consultant (Merck, Kiyatec), shareholder (Biopath), research funding (M-Trap). The following authors have no disclosures: PB, JAR-H, PS, AS, MO, LC, MB, BMF, JB, BZ, CL.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • 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.

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