Ur Metser MD, Presenter: Nothing to Disclose

Sarah Ferguson, Abstract Co-Author: Nothing to Disclose

Colin D. Jones MD, Abstract Co-Author: Nothing to Disclose

Lindsay Jacks, Abstract Co-Author: Nothing to Disclose

To retrospectively determine the diagnostic performance of 64-row MDCT in identifying, and quantifying peritoneal metastases in patients with ovarian cancer undergoing surgical staging or cytoreduction.

The institutional review board approved this retrospective study and waived the need to obtain informed patient consent. The study included 76 ovarian cancer patients who underwent surgical staging (n=11) or cytoreduction (n=65; primary debulking, n=35; neoadjuvant chemotherapy, n=30) and had 64-row MDCT before surgery (mean ± SD: 24 days ± 16.9) and surgical report. The peritoneal cavity was divided to 28 segments which were assessed for absence or presence of disease (<1cm or ≥ 1cm in diameter) on CT and at surgery. Success of cytoreductive surgery was recorded. The standard of reference was surgery, unless there was proof of a metastatic lesion as assessed by follow-up imaging or imaging before neoadjuvant chemotherapy. Sensitivity, specificity, and predictive accuracy of CT and surgery compared to the standard of reference were calculated. Generalized estimating equations for logistic regression were used to compare performance measures between CT and surgery.

A total of 1845 segments were evaluated. For all segments, the sensitivity, specificity and accuracy were 81.2%, 98.1%, 94.3% for CT & 87.4%, 100%, 97.2% for surgery (p=0.15; p=N/A; p=0.007), respectively. CT was less sensitive than surgery in detecting disease sites < 1cm (65.5% and 92.3%, respectively; p<0.0001), but not for detecting disease sites ≥1cm (89.3% and 84.9%, respectively; p=0.29). For patients who had primary debulking surgery, the sensitivity and accuracy were 81.9%, 94.1% for CT and 94.1%, 98.7% for surgery, (p=0.003; p<0.0001), respectively. But for those who received neoadjuvant chemotherapy the sensitivity and accuracy were 80%, 94.7% for CT, and 76.9%, 94.7% for surgery (p=0.71; p=1), respectively. Optimal cytoreduction was noted in 83% of patients at end of surgery, compared to 63% by standard of reference (p=0.0003, κ = 0.52).

MDCT has similar sensitivity as surgery for peritoneal metastases ≥1 cm. Detailed preoperative CT mapping of peritoneal metastases may have a role in improving surgical outcome, especially after neoadjuvant chemotherapy.

Detailed preoperative CT mapping of disease sites may potentially improve optimal cytoreduction rates for patients with metastatic ovarian cancer.

Metser, U, Ferguson, S, Jones, C, Jacks, L, Identification and Quantification of Peritoneal Metastases in Patients with Ovarian Cancer with 64-row Multidetector CT: Correlation with Surgery and Surgical Outcome.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9004820.html