Ultrasound in preoperative assessment of pelvis and abdominal spread in patients with ovarian cancer: a prospective study

abstract
Ultrasound in preoperative assessment of pelvis and abdominal spread in patients with ovarian cancer: a prospective study
 

Objective

To analyze the accuracy of ultrasound in assessing pelvic and intra-abdominal disease in patients with ovarian cancer.

Methods

This prospective study enrolled all consecutive patients referred to a single gynecologic oncology center for suspected ovarian cancer. Only data with histologically confirmed primary ovarian cancer in patients who were evaluated under predefined preoperative ultrasound, intraoperative and pathologic protocols were analyzed. The rectosigmoid wall infiltration depth, peritoneal involvement in different compartments and metastatic lymph node presence were correlated with histopathology.

Results

A total of 578 patients were enrolled from 2008 to 2013; 394 patients met the study criteria and their data were analysed, 74 % of them suffered from advanced stage cancer. Our results showed excellent agreement between ultrasound and histology in rectosigmoid wall infiltration assessment (kappa value 0.812, AUC 0.898). The overall accuracy in evaluating multiple abdominal peritoneal compartments and retroperitoneal lymph nodes reached 85.3 % and 84.5 %, respectively. A lower accuracy than 85 % was found in the assessment of diaphragm, infracolic omentum, mesentery and retroperitoneal lymph nodes but accuracy was at 90 % and higher for the evaluation of supracolic omentum, abdominal wall and visceral peritoneum (liver, spleen, small bowels, colon).

Conclusion

To the best of our knowledge, this is the largest imaging study on ovarian cancer staging done to date. In the study, ultrasound has shown high accuracy in evaluating the rectosigmoid wall infiltration. In assessing different peritoneal and retroperitoneal compartments, ultrasound was accurate and highly specific. However, similar to other modern imaging techniques, ultrasound revealed lower sensitivity, which further supported the role of comprehensive surgical staging.