Usefulness of computed tomography in predicting cytoreductive surgical outcomes for ovarian cancer

Abstract

Using specific CT findings from patients with ovarian cancer, we have devised two predictive models that have an accuracy of greater than 90% for predicting whether cytoreductive surgery will completely remove all tumor tissue, which should greatly aid in the differential decision-making as to whether to attempt cytoreductive surgery first, or to advance directly to neoadjuvant chemotherapy.

The Use of CT Findings to Predict Extent of Tumor at Primary Surgery for Ovarian Cancer

“…For example, Fujwara et al reported an association of implants in the small or large bowel mesentery, DPT, infrarenal para-aortic or pelvic lymph node involvement, omental caking, ascites fluid, and bowel encasement (≥2cm) with suboptimal cytoreduction in two separate models [18]. Simultaneously, Gerestein et al examined 115 patients and found DPT and the presence of ascites to be most predictive [19].…”

Computed tomography as a predictor of the extent of the disease and surgical outcomes in ovarian cancer

“…They created 2 predictive models both including diffuse peritoneal thickening, infrarenal para-aortic or pelvic lymph node involvement, a bowel encasement tumor (≥ 2 cm), and any tumor implants in the cul-de-sac. The accuracy rates of the models were 90.8% and 93.9% retrospectively [14]. For the same purpose, Bristow et al, identified 13 diagnostic features (peritoneal thickening, peritoneal implants > 2 cm, small and large bowel mesenteric disease > 2 cm, omental extension to stomach, spleen, or lesser sac, extension of the tumor to the pelvic sidewall/parametria/hydroureter, large-volume ascites, supra-and infrarenal lymph-adenopathy, diaphragm involvement, inguinal canal disease, liver lesions > 2 cm, and porta hepatis/gallbladder disease) and calculated the predictive score to predict the chances of optimal cytoreduction.…”

“…Regarding the upper abdominal region, involvement of the peritoneum, omentum, mesentery, small and large intestine, intra-extra parenchymal liver, diaphragm and retroperitoneal area can be detected by i.v. contrast CT scans [14]. However, it is a well-known fact that the most important limitation of CT in preoperative staging of OC is its inability to detect bowel surface, mesenteric, or peritoneal implants of < 5 mm reliably, especially in the absence of ascites [15,16].…”

“…To date, several studies have attempted to establish a predictive preoperative model to estimate successful tumor resectability, as well as to find predictors of suboptimal cytoreduction [8,10,11,14]. Fujwara et al, aimed to identify features of preoperative CT scans which can predict the outcomes of primary cytoreductive surgery in OC patients most successfully.…”

“…Using this model, the authors were able to predict the surgical outcome with a 93% accuracy [17]. However, multi-institutional validation showed an accuracy of only 34% to 46% [5,14,17]. Unfortunately, as reported by several studies, it is not www.…”