Skip to main content

Advertisement

SpringerLink
Log in

Advanced Primary Epithelial Ovarian and Peritoneal Carcinoma—Does Diagnostic Accuracy of Preoperative CT Scan for Detection of Peritoneal Metastatic Sites Reflect into Prediction of Suboptimal Debulking? A Prospective Study

  • Original Article
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Ovarian cancer is the seventh most common cancer in females worldwide. Optimal debulking is the standard treatment but possible only in 30–85% of advanced stages. Knowing exactly the disease extent preoperatively may predict suboptimal debulking. We analyzed diagnostic accuracy of preoperative CT scan in disease mapping and prediction of suboptimal debulking in a prospective observational study from March 2013 to May 2015 in a tertiary hospital. Adults below the age of 75 years with ECOG PS-0, 1, 2, clinically/radiologically newly diagnosed stage IIIc epithelial ovarian (EOC), and primary peritoneal carcinoma (PPC) were included. Neoadjuvant chemotherapy recipients were excluded. Preoperative multidetector CT (MDCT) scan showing deposits at 19 predetermined abdominopelvic sites were compared with the same sites seen at laparotomy and corresponding accuracies of CT scan calculated. Primary debulking surgery was done to achieve debulking to nil or less than 1-cm residual disease. Stepwise logistic regression models were used to determine the frequent suboptimal debulking sites and the predictive performance of the clinical and CT scan findings. A total of 36 patients were enrolled. The optimal debulking rate was 50%. The CT scan could detect the disease-bearing sites with overall sensitivity of 68.29%, specificity of 89%, accuracy of 78.07%, and positive and negative predictive values of 99 and 50.1%, respectively. Upon multivariate analysis, bowel mesentery (p 0.011) and omental extension (p 0.025) were associated with suboptimal debulking. CT scan accuracy at these sites (predictive performance) was 86.1%. We identified small bowel mesentery and omental extension (to spleen/stomach/colon) as sites associated with suboptimal debulking. MDCT accurately depicts peritoneal metastases, although sensitivity is reduced in certain areas of significance for optimal debulking. Further validation with more number of patients is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ferlay J, Soerjomataram I Ervik IM et al. (2013). GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer. Available from http://globocan.iarc.fr date accessed-22/08/2015

  2. Heintz AP, Odicino F, Maisonneuve P et al (2003) Carcinoma of the ovary. Int J Gynaecol Obstet 83(Suppl 1):135–166

    Article  PubMed  Google Scholar 

  3. Pecorelli S, Favalli G, Zigliani L et al (2003) Cancer in women. Int J Gynaecol Obstet 82:369–379

    Article  CAS  PubMed  Google Scholar 

  4. Armstrong DK, Bundy B, Wenzel L et al (2006) Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 354:34–43

    Article  CAS  PubMed  Google Scholar 

  5. Ozols RF, Bundy BN, Greer BE et al (2003) Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a gynecologic oncology group study. J Clin Oncol 21:3194–3200

    Article  CAS  PubMed  Google Scholar 

  6. Shih KK, Chi DS (2010) Maximal cytoreductive effort in epithelial ovarian cancer surgery. J Gynecol Oncol 21:75–80

    Article  PubMed  PubMed Central  Google Scholar 

  7. Chi DS, Eisenhauer EL, Lang J et al (2006) What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)? Gynecol Oncol 103:559–564

    Article  CAS  PubMed  Google Scholar 

  8. Eisenkop SM, Friedman RL, Wang HJ (1998) Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study. Gynecol Oncol 69(2):103–108

    Article  CAS  PubMed  Google Scholar 

  9. Bristow RE, Tomacruz RS, Armstrong DK (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 20:1248–1259

    Article  PubMed  Google Scholar 

  10. Aletti GD, Dowdy SC, Gostout BS et al (2006) Aggressive surgical effort and improved survival in advanced-stage ovarian cancer. Obstet Gynecol 107:77–85

    Article  PubMed  Google Scholar 

  11. Salani R, Zahurak ML, Santillan A (2007) Survival impact of multiple bowel resections in patients undergoing primary cytoreductive surgery for advanced ovarian cancer: a case–control study. Gynecol Oncol 107(3):495–499

    Article  PubMed  Google Scholar 

  12. Winter WE, Maxwell GL, Tian C et al (2008) Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol 26(1):83–89

    Article  PubMed  Google Scholar 

  13. Winter WE, Maxwell GL, Tian C et al (2007) Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol 25:3621–3627

    Article  PubMed  Google Scholar 

  14. Bristow RE, Duska LR, Lambrou NC et al (2000) A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography. Cancer 89:1532–1540

    Article  CAS  PubMed  Google Scholar 

  15. Dowdy SC, Mullany SA, Brandt KR et al (2004) The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma. Cancer 101:346–352

    Article  PubMed  Google Scholar 

  16. Qayyum A, Coakley FV, Westphalen AC (2005) Role of CT and MR imaging in predicting optimal cytoreduction of newly diagnosed primary epithelial ovarian cancer. Gynecol Oncol 96:301–306

    Article  PubMed  Google Scholar 

  17. Suidan RS, Ramirez PT, Sarasohn DM (2014) A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer. Gynecol Oncol 134(3):455–461

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Fagotti A, Ferrandina G, Fanfani F et al (2006) A laparoscopy-based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study. Ann Surg Oncol 13(8):1156–1161

    Article  PubMed  Google Scholar 

  19. Kang S, Kim T-J, Nam B-H et al (2010) Preoperative serum CA-125 levels and risk of suboptimal cytoreduction in ovarian cancer: a meta-analysis. J Surg Oncol 101:13–17

    Article  CAS  PubMed  Google Scholar 

  20. Tempany CM, Zou KH, Silverman SG et al (2000) Staging of advanced ovarian cancer: comparison of imaging modalities—report from the Radiological Diagnostic Oncology Group. Radiology 215:761–767

    Article  CAS  PubMed  Google Scholar 

  21. Axtell AE, Lee MH, Bristow RE et al (2007) Multi-institutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoreduction in patients with advanced ovarian cancer. J Clin Onco 25(4):384–389

    Article  Google Scholar 

  22. Gemer MG, Ravid M et al (2009) A multicenter validation of computerized tomography models as predictors of non-optimal primary cytoreduction of advanced epithelial ovarian cancer. EJSO 35:1109–1112

    Article  CAS  PubMed  Google Scholar 

  23. Meyers MA (1973) Distribution of intra-abdominal malignant seeding: dependency on dynamics of flow of ascitic fluid. Am J Roentgenol Radium TherNucl Med 119:198–206

    Article  CAS  Google Scholar 

  24. Brockbank EC, Ind TE, Barton DP et al (2004) Preoperative predictors of suboptimal primary surgical cytoreduction in women with clinical evidence of advanced primary epithelial ovarian cancer. Int J Gynecol Cancer 14(1):42–50

    Article  CAS  PubMed  Google Scholar 

  25. Goff BA, Mandel LS, Drescher CW et al (2007) Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer 109(2):221–227

    Article  PubMed  Google Scholar 

  26. Aletti GD, Gostout BS, Podratz KC et al (2006) Ovarian cancer surgical resectability: relative impact of disease, patient status, and surgeon. Gynecol Oncol 100:33–37

    Article  PubMed  Google Scholar 

  27. Ferrandina G, Sallustio G, Fagotti A et al (2009) Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial. Br J Cancer 101:1066–1073

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Chandrashekhara SH, Thulkar S, Srivastava DN et al (2011) Pre-operative evaluation of peritoneal deposits using multidetector computed tomography in ovarian cancer. Br J Radiol 84:38–43

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Ur Metser, Colin Jones, Lindsay M. Jacks et al. (2011). Identification and quantification of peritoneal metastases in patients with ovarian cancer with multidetector computed tomography: correlation with surgery and surgical outcome. Int J Gynecol Cancer;21: 1391–1398

  30. Buy JN, Moss AA, Ghossain MA et al (1988) Peritoneal implants from ovarian tumors: CT findings. Radiology 169(3):691–694

    Article  CAS  PubMed  Google Scholar 

  31. Coakley FV, Choi PH, Gougoutas CA et al (2002) Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology 223:495–499

    Article  PubMed  Google Scholar 

  32. Vergote I, Trope CG, Amant F et al (2010) Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 363(10):943–953

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Amrita Institute of Medical Sciences, Ponekkara PO, Kochi, Kerala, 682 041, India

    Kiran Bagul, D. K Vijaykumar, Anupama Rajanbabu, Mitchelle Aline Antony & Venkatesan Ranganathan

Authors
  1. Kiran Bagul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. K Vijaykumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anupama Rajanbabu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mitchelle Aline Antony
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Venkatesan Ranganathan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kiran Bagul.

Ethics declarations

All the patients were counseled regarding the nature of the surgery and possible complications. All the patients gave written consent for the study. The study was approved by the ethical committee of the institution.

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bagul, K., Vijaykumar, D.K., Rajanbabu, A. et al. Advanced Primary Epithelial Ovarian and Peritoneal Carcinoma—Does Diagnostic Accuracy of Preoperative CT Scan for Detection of Peritoneal Metastatic Sites Reflect into Prediction of Suboptimal Debulking? A Prospective Study. Indian J Surg Oncol 8, 98–104 (2017). https://doi.org/10.1007/s13193-016-0601-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13193-016-0601-6

Keywords

Search

Navigation