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Functional tumour burden of peritoneal carcinomatosis derived from DWI could predict incomplete tumour debulking in advanced ovarian carcinoma

  • Oncology
  • Published:
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Abstract

Objectives

To investigate the predictive value of peritoneal carcinomatosis (PC) quantification by DWI in determining incomplete tumour debulking in ovarian carcinoma (OC).

Methods

Prospective patients with suspected stage III–IV or recurrent OC were recruited for DWI before surgery. PC on DWI was segmented semi-automatically by k-means clustering, retaining voxels with intermediate apparent diffusion coefficient (ADC) to quantify PC burden. A scoring system, functional peritoneal cancer index (fPCI), was proposed based on the segmentation of tumour volume in 13 abdominopelvic regions with additional point given to involvement of critical sites. ADC of the largest PC was recorded. The surgical complexity and outcomes (complete vs. incomplete tumour debulking) were documented. fPCI was correlated with surgical PCI (sPCI), surgical complexity, and its ability to predict incomplete tumour debulking.

Results

Fifty-three patients with stage III–IV or recurrent OC were included with a mean age of 56.1 ± 11.8 years old. Complete tumour debulking was achieved in 38/53 patients (71.7%). Significant correlation was found between fPCI and sPCI (r > 0.757, p < 0.001). Patients with high-fPCI (fPCI ≥ 6) had a high surgical complexity score (p = 0.043) with 84.2% received radical or supra-radical surgery. The mean fPCI was significantly higher in patients with incomplete tumour debulking than in those with complete debulking (10.27 vs. 4.71, p < 0.001). fPCI/ADC combined with The International Federation of Gynecology and Obstetrics stage achieved 92.5% accuracy in predicting incomplete tumour debulking (AUC 0.947).

Conclusions

DWI-derived fPCI offered a semi-automated estimation of PC burden. fPCI/ADC could predict the likelihood of incomplete tumour debulking with high accuracy.

Key Points

• Functional peritoneal cancer index (fPCI) derived from DWI offered a semi-automated estimation of tumour burden in ovarian carcinoma.

• fPCI was highly correlated with surgical PCI (sPCI).

• fPCI/ADC could predict the likelihood of incomplete tumour debulking with high accuracy.

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Abbreviations

CA-125:

Cancer antigen-125

CS:

Complexity score

FIGO:

The International Federation of Gynecology and Obstetrics

fPCI:

Functional peritoneal cancer index

FTV:

Functional tumour volume

IDS:

Interval debulking surgery

NACT:

Neoadjuvant chemotherapy

OC:

Ovarian carcinoma

PC:

Peritoneal carcinomatosis

sPCI:

Surgical peritoneal cancer index

UDS:

Upfront debulking surgery

VOI:

Volumes of interest

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Funding

Dr. Elaine YP Lee, Dr. Edward S Hui and Prof. Hextan YS Ngan were investigators of the research grant from Health and Medical Research Fund, Hong Kong (No. 03143616), which supported this study.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong

    Elaine Y. P. Lee, He An, Jose A. U. Perucho, Keith W. H. Chiu & Edward S. Hui

  2. Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong

    Mandy M. Y. Chu & Hextan Y. S. Ngan

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  1. Elaine Y. P. Lee
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  2. He An
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  3. Jose A. U. Perucho
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Correspondence to Elaine Y. P. Lee.

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Guarantor

The scientific guarantor of this publication is Dr. Elaine YP LEE.

Conflict of Interest

Dr. Elaine YP Lee, Dr. Edward S Hui and Prof. Hextan YS Ngan were investigators of the research grant from Health and Medical Research Fund, Hong Kong (No. 03143616), which supported this study. The rest of authors have no conflicts of interest to declare.

Statistics and Biometry

No complex statistical methods were necessary for this paper.

Informed Consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical Approval

This prospective cohort study was approved by local Institutional Research Ethics Committee (HKU/HA HKW IRB UW 15-536).

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• performed at one institution

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Lee, E.Y.P., An, H., Perucho, J.A.U. et al. Functional tumour burden of peritoneal carcinomatosis derived from DWI could predict incomplete tumour debulking in advanced ovarian carcinoma. Eur Radiol 30, 5551–5559 (2020). https://doi.org/10.1007/s00330-020-06887-6

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  • DOI: https://doi.org/10.1007/s00330-020-06887-6

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