PURPOSE:
To evaluate the accuracy of
MDCT in the preoperative definition of Peritoneal
Cancer Index (PCI) in patients with advanced
ovarian cancer
who underwent a
peritonectomy and hyperthermic intraperitoneal
chemotherapy (HIPEC) after neoadjuvant chemotherapy to obtain a
pre-surgery prognostic evaluation and a prediction of optimal
cytoreduction surgery.
MATERIALS AND METHODS:
Pre-HIPEC CT examinations of 43 patients with advanced
ovarian cancer
after
neoadjuvant chemotherapy were analyzed by two radiologists. The
PCI was scored according to the Sugarbaker classification, based on
lesion size and distribution. The results were compared with macroscopic
and histologic data after peritonectomy and HIPEC. To evaluate the
accuracy of MDCT to detect and localize peritoneal carcinomatosis, both
patient-level and regional-level analyses were conducted. A correlation
between PCI CT and histologic values for each patient was searched
according to the PCI grading.
RESULTS:
Considering the
patient-level analysis, CT shows a sensitivity, specificity, PPV, NPV,
and an accuracy in detecting the peritoneal carcinomatosis of 100 %,
40 %, 93 % 100 %, and 93 %, respectively. Considering the regional level
analysis, a sensitivity, specificity, PPV, NPV, and diagnostic accuracy
of 72 %, 80 %, 66 %, 84 %, and 77 %, respectively were obtained for the
correlation between CT and histology.
CONCLUSION:
Our
results encourage the use of MDCT as the only technique sufficient to
select patients with peritoneal carcinomatosis for cytoreductive surgery
and HIPEC on the condition that a CT examination will be performed
using a dedicated protocol optimized to detect minimal peritoneal
disease and CT images will be analyzed by an experienced reader.
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