To analyze the ability of magnetic resonance imaging (MRI) and systematic evaluation at surgery to predict optimal cytoreduction in primary advanced ovarian cancer and to develop a preoperative scoring system for cancer staging.
Preoperative MRI and standard laparotomy were performed in 99 women with either ovarian or primary peritoneal cancer. Using univariate and multivariate logistic regression analysis of a systematic description of the tumor in nine abdominal compartments obtained by MRI and during surgery plus clinical parameters, a scoring system was designed that predicted non-optimal cytoreduction.
Non-optimal cytoreduction at operation was predicted by the following: (A) presence of comorbidities group 3 or 4 (ASA); (B) tumor presence in multiple numbers of different compartments, and (C) numbers of specified sites of organ involvement. The score includes: number of compartments involved (1–9 points), >1 subdiaphragmal location with presence of tumor (1 point); deep organ involvement of liver (1 point), porta hepatis (1 point), spleen (1 point), mesentery/vessel (1 point), cecum/ileocecal (1 point), rectum/vessels (1 point): ASA groups 3 and 4 (2 points). Use of the scoring system based on operative findings gave an area under the curve (AUC) of 91% (85–98%) for patients in whom optimal cytoreduction could not be achieved. The score AUC obtained by MRI was 84% (76–92%), and 43% of non-optimal cytoreduction patients were identified, with only 8% of potentially operable patients being falsely evaluated as suitable for non-optimal cytoreduction at the most optimal cut-off value. Tumor in individual locations did not predict operability.
This systematic scoring system based on operative findings and MRI may predict non-optimal cytoreduction. MRI is able to assess ovarian cancer with peritoneal carcinomatosis with satisfactory concordance with laparotomic findings. This scoring system could be useful as a clinical guideline and should be evaluated and developed further in larger studies.
Abbreviations:ASA (American Society of Anesthesiologists. Referring to the co-morbidities scoring index), AUC (area under curve), BMI (body mass index (BMI)), Ca125 (cancer antigen 125), CT (computed tomography), DWI (diffusion-weighted imaging), FDG-Pet (fluordeoxyglucose-positron emissions topography), LHRs (likelihood ratio), MRI (magnetic resonance imaging), NPV (negative predictive value), OC (ovarian cancer), ORs (odds ratios), PCI (peritoneal cancer index), PPC (primary peritoneal cancer), PPV (positive predictive value)
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Published online: October 28, 2016
Accepted: October 21, 2016
Received in revised form: September 27, 2016
Received: April 14, 2016
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