Skip to main content

Advertisement

SpringerLink
Log in

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)

  • Published:
Abdominal Imaging Aims and scope Submit manuscript

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.

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
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

PC:

Peritoneal carcinomatosis

PCI:

Peritoneal Cancer Index

CRS:

Cytoreductive surgery

HIPEC:

Hyperthermic intraperitoneal chemotherapy

SE:

Surgical examination

HE:

Histologic examination

References

  1. Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  3. Seton-Rogers S (2013) Ovarian cancer: at the starting line. Nat Rev Cancer. doi:10.1038/nrc3510

    Google Scholar 

  4. Nougaret S, Addley HC, Colombo PE, et al. (2012) Ovarian carcinomatosis: how the radiologist can help plan the surgical approach. Radiographics 32:1775–1800. doi:10.1148/rg.326125511

    Article  PubMed  Google Scholar 

  5. Glehen O, Mohamed F, Gilly FN (2004) Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia. Lancet Oncol 5:219–228

    Article  PubMed  Google Scholar 

  6. Stewart JH 4th (2005) Shen P, Levine EA (2005) Intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: current status and future directions. Ann Surg Oncol 12:765–777

    Article  PubMed  Google Scholar 

  7. Roviello F, Caruso S, Marrelli D, et al. (2011) Treatment of peritoneal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: state of the art and future developments. Surg Oncol 20:38–54. doi:10.1016/j.suronc.2010.09.002

    Article  Google Scholar 

  8. Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221:29–42

    Article  PubMed  CAS  Google Scholar 

  9. Sugarbaker PH (2009) Cytoreductive surgery and perioperative intraperitoneal chemotherapy for the treatment of advanced primary and recurrent ovarian cancer. Curr Opin Obstet Gynecol 21:15–24. doi:10.1097/GCO.0b013e32831f8f32

    Article  PubMed  Google Scholar 

  10. Roviello F, Pinto E, Corso G, et al. (2010) Safety and potential benefit of hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal carcinomatosis from primary or recurrent ovarian cancer. J Surg Oncol 102:663–670. doi:10.1002/jso.21682

    Article  PubMed  Google Scholar 

  11. Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82:359–374

    Article  PubMed  CAS  Google Scholar 

  12. Pfannenberg C, Königsrainer I, Aschoff P, et al. (2009) (18)F-FDG-PET/CT to select patients with peritoneal carcinomatosis for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Int Ann Surg Oncol 16:1295–1303. doi:10.1245/s10434-009-0387-7

    Article  Google Scholar 

  13. Limei Z, Yong C, Yan X, et al. (2013) Accuracy of positron emission tomography/computed tomography in the diagnosis and restaging for recurrent ovarian cancer: a meta-analysis. Int J Gynecol Cancer 23:598–607

    Article  PubMed  Google Scholar 

  14. Klumpp BD, Aschoff P, Schwenzer N, et al. (2012) Peritoneal carcinomatosis: comparison of dynamic contrast-enhanced magnetic resonance imaging with surgical and histopathologic findings. Abdom Imaging 37:834–842

    Article  PubMed  Google Scholar 

  15. Funicelli L, Travaini LL, Landoni F, et al. (2010) Peritoneal carcinomatosis from ovarian cancer: the role of CT and [1F]FDG-PET/CT. Abdom Imaging 35:701–707. doi:10.1007/s00261-009-9578-8

    Article  PubMed  CAS  Google Scholar 

  16. Kim HW, Won KS, Zeon SK, Ahn BC, Gayed IW (2013) Peritoneal carcinomatosis in patients with ovarian cancer: enhanced CT versus 18F-FDG PET/CT. Clin Nucl Med 38:93–97. doi:10.1097/RLU.0b013e31826390ec

    Article  PubMed  Google Scholar 

  17. Low RN (2007) MR imaging of the peritoneal spread of malignancy. Abdom Imaging 32:267–283

    Article  PubMed  Google Scholar 

  18. Roviello F, Marrelli D, Neri A, et al. (2006) Treatment of peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (IHCP): postoperative outcome and risk factors for morbidity. World J Surg 30:2033–2040

    Article  PubMed  Google Scholar 

  19. Sant M, Allemani C, Santaquilani M, et al. (2009) EUROCARE-4. Survival of cancer patients diagnosed in 1995–1999. Results and commentary. Eur J Cancer 45:931–991. doi:10.1016/j.ejca.2008.11.018

    Article  PubMed  Google Scholar 

  20. Verwaal VJ, van Ruth S, de Bree E, et al. (2003) Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 21:3737–3743

    Article  PubMed  Google Scholar 

  21. Bijelic L, Jonson A, Sugarbaker PH (2007) Systematic review of cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis in primary and recurrent ovarian cancer. Ann Oncol 18:1943–1950

    Article  PubMed  CAS  Google Scholar 

  22. Hamilton T, Lanuke K, Mack LA, Temple WJ (2011) Long-term follow-up in the treatment of peritoneal carcinomatosis. Am J Surg 201:650–654

    Article  PubMed  Google Scholar 

  23. Sala E, Kataoka M, Pandit-Taskar N, et al. (2010) Recurrent ovarian cancer: use of contrast-enhanced CT and PET/CT to accurately localize tumor recurrence and to predict patients’ survival. Radiology 257:125–134

    Article  PubMed  Google Scholar 

  24. Satoh Y, Ichikawa T, Motosugi U, et al. (2011) Diagnosis of peritoneal dissemination: comparison of 18F-FDG PET/CT, diffusion-weighted MRI, and contrast-enhanced MDCT. AJR Am J Roentgenol 196:447–453

    Article  PubMed  Google Scholar 

  25. De Bree E, Koops W, Kroger R, et al. (2004) Peritoneal carcinomatosis from colorectal cancer or appendiceal origin: correlation of preoperative CT with intraoperative findings and evaluation of interobserver agreement. J Surg Oncol 86:64–73

    Article  PubMed  Google Scholar 

  26. 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 

  27. Marin D, Catalano C, Baski M, et al. (2010) 64-Section multi-detector row CT in the preoperative diagnosis of peritoneal carcinomatosis: correlation with histopathological findings. Abdom Imaging 35:694–700. doi:10.1007/s00261-008-9464-9

    Article  PubMed  Google Scholar 

  28. Berger KL, Nicholson SA, Dehdashti F, Siegel BA (2000) FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features. Am J Roentgenol 174:1005–1008

    Article  CAS  Google Scholar 

  29. Mazzei MA, Cioffi Squitieri N, Sani E, et al. (2013) Differences in perfusion CT parameter values with commercial software upgrades: a preliminary report about algorithm consistency and stability. Acta Radiol. doi:10.1177/0284185113484643.

Download references

Acknowledgments

We thank Ms. Julia Hassall for reviewing the English.

Author information

Authors and Affiliations

  1. Section of Radiological Sciences, Department of Medical, Surgical and Neuro Sciences, University of Siena, Viale Bracci 10, 53100, Siena, Italy

    Maria Antonietta Mazzei, Leila Khader, Alfredo Cirigliano, Nevada Cioffi Squitieri, Susanna Guerrini, Beatrice Forzoni & Luca Volterrani

  2. Section of Surgery, Department of Medical, Surgical and Neuro Sciences, University of Siena, Viale Bracci 10, 53100, Siena, Italy

    Daniele Marrelli & Franco Roviello

  3. Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100, Siena, Italy

    Francesco Giuseppe Mazzei

Authors
  1. Maria Antonietta Mazzei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leila Khader
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alfredo Cirigliano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nevada Cioffi Squitieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Susanna Guerrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Beatrice Forzoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniele Marrelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Franco Roviello
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francesco Giuseppe Mazzei
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Luca Volterrani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Antonietta Mazzei.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mazzei, M.A., Khader, L., Cirigliano, A. et al. 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). Abdom Imaging 38, 1422–1430 (2013). https://doi.org/10.1007/s00261-013-0013-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-013-0013-9

Keywords

Search

Navigation