Ovarian cancer affects around 7500 women in the United Kingdom every year. Despite this, there is no effective screening strategy or standard treatment for ovarian cancer. If diagnosed during stage I, ovarian cancer has a 90% 5-year survival rate; however, there is usually a masking of symptoms which leads to an often late-stage diagnosis and correspondingly poor survival rate. Current diagnostic methods are invasive and consist of a pelvic examination, transvaginal ultrasonography, and blood tests to detect cancer antigen 125 (CA125). Unfortunately, surgery is often still required to make a positive diagnosis. To address the need for accurate, specific, and non-invasive diagnostic methods, there has been an increased interest in biomarkers identified through non-invasive tests as tools for the earlier diagnosis of ovarian cancer. Although most studies have focused on the identification of biomarkers in blood, the ease of availability of urine and the high patient compliance rates suggest that it could provide a promising resource for the screening of patients for ovarian cancer.

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Results The kappa inter-rater agreement was À0.017 (95% CI 0.023 to À0.005), indicating low inter-rater agreement between radiology and actual laparoscopic score. The ICC was 0.06 (0.02-0.21), indicating that surgeons do not score the same across all images. When using a PIV cutoff of 8, the probability of agreement between radiology and actual laparoscopic score was 0.56 (95% CI 0.49-0.73). When looking at disease site subscales, the probability of agreement was (95% CI): peritoneum 0.57 (0.51-0.62), diaphragm 0.54 (0.48-0.60), mesentery 0.51 (0.45-0.57), omentum 0.61 (0.55-0.67), bowel 0.54 (0.44-0.64), stomach 0.71 (CI 0.65-0.76), and liver 0.36 (CI 0.31-0.42). Conclusions Surgeon radiology review did not highly correlate with actual laparoscopy findings. By subscale, the best agreement is seen when evaluating for stomach involvement, and the worst with liver involvement. Our study highlights the benefits of laparoscopic assessment to determine resectability over radiology alone.

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