Abstract
Objective
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.
Study design
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.
Results
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.
Conclusion
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)Keywords
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References
- Primary surgery or neoadjuvant chemotherapy in ovarian cancer: what is the value of comparing apples with oranges?.Gynecol Oncol. 2012; 124: 1-2
- Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer.N Engl J Med. 2010; 363: 943-953
- Role of maximal primary cytoreductive surgery in patients with advanced epithelial ovarian and tubal cancer: surgical and oncological outcomes. Single institution experienc.Gynecol Oncol. 2010; 119: 259-264
- Quality improvement in the surgical approach to advanced ovarian cancer: the Mayo Clinic experience.J Am Coll Surg. 2009; 208: 614-620
- Primary surgery or neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer.Eur J Cancer. 2011; 47: S88-S92
- The intraoperative staging systems in the management of peritoneal surface malignancy.J Surg Oncol. 2008; 98: 228-231
- Quantitative prognostic indices in peritoneal carcinomatosis.Eur J Surg Oncol. 2006; 32: 597-601
- Prognostic indicators in peritoneal carcinomatosis from gastrointestinal cancer.Int Semin Surg Oncol. 2005; 2: 3
- Quantitative prognostic indicators of peritoneal dissemination of gastric cancer.Eur J Surg Oncol. 2006; 32: 602-606
- Treatment and prevention of peritoneal carcinomatosis from colorectal cancer.Surg Oncol Clin N Am. 2003; 12: 543-559
- Limited utility of conventional criteria for predicting unresectable disease in patients with advanced stage epithelial ovarian cancer.Gynecol Oncol. 2008; 108: 271-275
- Ultrasound evaluation of intra-abdominal sites of disease to predict likelihood of suboptimal cytoreduction in advanced ovarian cancer: a prospective study.Ultrasound Obstet Gynecol. 2012; 39: 99-105
- Ultrasound scanning of the pelvis and abdomen for staging of gynecological tumors: a review.Ultrasound Obstet Gynecol. 2011; 38: 246-266
- Role of CT and MR imaging in predicting optimal cytoreduction of newly diagnosed primary epithelial ovarian cancer.Gynecol Oncol. 2005; 96: 301-306
- Multi-institutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoreduction in patients with advanced ovarian cancer.J Clin Oncol. 2007; 25: 384-389
- Ovarian Cancer Management: the role of imaging and diagnostic challenges.Eur J Radiol. 2011; 78: 41-51
- Ultrasonography, computed tomography and magnetic resonance imaging in the assessment of pelvic pathology.Eur J Radiol. 2006; 58: 147-155
- Accuracy of ultrasonography with color doppler in ovarian tumor: a systematic quantitative review.Int J Gynecol Cancer. 2009; 19: 1214-1220
- MRI in ovarian cancer.Imaging Med. 2012; 4: 59-75
- Indeterminate adnexal masses at ultrasound: effect of MRI imaging findings on diagnostic thinking and therapeutic decisions.Eur Radiol. 2011; 21: 1301-1310
- Early diagnosis of ovarian carcinoma: is a solution in sight.Radiology. 2011; 259: 329-345
- Diagnosis and staging of primary ovarian cancer: correlation between PET/CT, Doppler US, and CT or MRI.Gynecol Oncol. 2010; 116: 389-394
- ESUR guidelines for MR imaging of the sonographically indeterminate adnexal mass: an algorithmic approach.Eur Radiol. 2010; 20: 25-35
- Magnetic resonance (MR) imaging of suspected ovarian cancer.BJOG. 2008; 115: 811-813
- Radiological assessment of gynecologic malignancies.Obstet Gynecol Clin North Am. 2011; 38: 45-68
- Peritoneal cancer index: a prognostic indicator of survival in advanced ovarian cancer.Eur J Surg Oncol. 2003; 29: 69-73
- Prediction of suboptimal primary cytoreduction in primary ovarian cancer with combined positron emission tomography/computed tomography—a prospective study.Gynecol Oncol. 2008; 108: 265-270
- FDG-PET/CT in advanced ovarian cancer staging: value and pitfalls in detecting lesions in different abdominal and pelvic quadrants compared with laparoscopy.Eur J Radiol. 2011; 80: e98-e103
- External validation of a laparoscopic-based score to evaluate resectability of advanced ovarian cancers: clues for a simplified score.Gynecol Oncol. 2008; 110: 354-359
- Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma.Am J Obstet Gynecol. 2008; 199: 642e1-642e6
- Port-site metastases after open laparoscopy: a study in 173 patients with advanced ovarian carcinoma.Int J Gynecol Cancer. 2005; 15: 776-779
- Laparoscopic port-site metastases in patients with gynecological malignancies.Int J Gynecol Cancer. 2004; 14: 1070-1077
- Predicting surgical outcome for advanced ovarian cancer, surgical standards of care, and the concept of kaizen.Gynecol Oncol. 2009; 112: 1-3
Article info
Publication history
Published online: October 28, 2016
Accepted:
October 21,
2016
Received in revised form:
September 27,
2016
Received:
April 14,
2016
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
