The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma

Abstract

BACKGROUNDComputed tomography (CT) scans of the abdomen and pelvis may predict which patients with ovarian carcinoma can undergo optimal cytoreduction at primary surgery. Previous studies have demonstrated that patients with ovarian carcinoma had optimal cytoreduction rates ranging from 50–60%. The authors sought to determine whether these findings applied to a surgical practice with a higher rate of optimal debulking. A predictive model using CT scanning and CA 125 values would allow the authors to determine which patients would be more appropriately treated with neoadjuvant chemotherapy.METHODSPreoperative CT scans for patients with Stage III/IV ovarian carcinoma (according to the staging system of the International Federation of Gynecology and Obstetrics) who were treated between 1996 and 2001 were evaluated retrospectively by 2 radiologists for 17 criteria evaluating the extent of disease. Clinical data were extracted from medical records. Residual tumors measuring ≥ 1 cm were considered suboptimal. Logistic regression was used to evaluate which criteria correlated with optimal cytoreduction.RESULTSEighty‐seven patients were identified retrospectively who met entry criteria and had preoperative CT scans of sufficient diagnostic quality. Sixty‐two patients (71%) received optimal cytoreductive surgery and 45 (52%) required aggressive surgical procedures. In a multivariate model, only diffuse peritoneal thickening (DPT) independently predicted suboptimal surgical resection (P = 0.016). However, a model using both DPT and ascites on most CT scans had a positive predictive value of 68% and a sensitivity of 52% for predicting suboptimal cytoreduction.CONCLUSIONSThe presence of DPT and large‐volume ascites was associated with a very low rate of optimal cytoreduction (32%) in a surgical practice. These patients may be more appropriately treated with neoadjuvant chemotherapy followed by surgical cytoreduction. Cancer 2004. © 2004 American Cancer Society.

Comparative study of pre-operative CT scan and per-operative findings in carcinoma ovary

“…Previous investigators assessing the utility of preoperative CT scan in this setting have retrospectively identified different radiologic predictors. [14][15][16][17][18] Axtell et al's analysis of 65 patients showed diaphragm disease and large bowel mesentery implants to be significant factors. 15 Dowdy et al's review of 89 patients found diffuse peritoneal thickening to be the only variable significantly associated with suboptimal debulking which is comparable to our study.…”

“…These scores were added together for a score of 0 to 10 which was compared to the surgical results. [14][15][16]22,23 Blood samples for measurement of CA125, within four weeks prior to surgery. CA125 was assessed by enzyme immunoassay (Roche E170) using a sandwich method with chemoluminescence.…”

“…14,17,18 Accuracy of prediction using such parameters ranges between 71 and 93%. [14][15][16] However, discrepancies across the studies and reliability of the results are also conceivably related to the time frame, and duration of accrual as variations and/or improvements in the imaging techniques, equipment, and performances have occurred over time, and also diverge across different imaging centres.…”

Mini-laparotomy in advanced ovarian cancer

“…This modality of assessment, in experienced hands, has been shown to have PPV of 87% and NPV of 100% [20][21][22]. However, laparoscopic assessment requires an experienced surgical team and laparoscopic resources.…”

Prognostic factors for surgical outcome and survival in 447 women treated for advanced (FIGO-stages III-IV) epithelial ovarian carcinoma

“…It is not completely understood whether the intrinsic biological behavior of the tumor or the skill of the surgeon is the main determinant of optimal cytoreduction. Several studies (2,6,(7)(8)(9)(10)(11)(12) have been performed to find preoperative methods or models on the basis of imaging, amount of ascites, serum marker CA-125 or molecular tissue markers that can predict the surgical outcome. As the prediction rates in these studies have a wide range, it is not clear whether the results are dependent on patient selection or type of hospital.…”