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Abdominal Imaging

, Volume 38, Issue 6, pp 1422–1430 | Cite as

Accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC)

  • Maria Antonietta MazzeiEmail author
  • Leila Khader
  • Alfredo Cirigliano
  • Nevada Cioffi Squitieri
  • Susanna Guerrini
  • Beatrice Forzoni
  • Daniele Marrelli
  • Franco Roviello
  • Francesco Giuseppe Mazzei
  • Luca Volterrani
Article

Abstract

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.

Keywords

Multi-detector computed tomography (MDCT) Peritoneal carcinomatosis Hyperthermic intraperitoneal chemotherapy Ovarian cancer Cancer diagnosis 

Abbreviations

PC

Peritoneal carcinomatosis

PCI

Peritoneal Cancer Index

CRS

Cytoreductive surgery

HIPEC

Hyperthermic intraperitoneal chemotherapy

SE

Surgical examination

HE

Histologic examination

Notes

Acknowledgments

We thank Ms. Julia Hassall for reviewing the English.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Maria Antonietta Mazzei
    • 1
    Email author
  • Leila Khader
    • 1
  • Alfredo Cirigliano
    • 1
  • Nevada Cioffi Squitieri
    • 1
  • Susanna Guerrini
    • 1
  • Beatrice Forzoni
    • 1
  • Daniele Marrelli
    • 2
  • Franco Roviello
    • 2
  • Francesco Giuseppe Mazzei
    • 3
  • Luca Volterrani
    • 1
  1. 1.Section of Radiological Sciences, Department of Medical, Surgical and Neuro SciencesUniversity of SienaSienaItaly
  2. 2.Section of Surgery, Department of Medical, Surgical and Neuro SciencesUniversity of SienaSienaItaly
  3. 3.Department of Diagnostic ImagingAzienda Ospedaliera Universitaria SeneseSienaItaly

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