Prediction of suboptimal primary cytoreduction in primary ovarian cancer with combined positron emission tomography/computed tomography--a prospective study.
ABSTRACT To prospectively identify combined PET/CT predictors of incomplete/suboptimal primary cytoreduction in advanced ovarian cancer.
From September 2004 to March 2007, 179 patients with a Risk of Malignancy Index (RMI) >150 based on serum CA-125, ultrasound examinations and menopausal state, underwent PET/CT within 2 weeks prior to standard surgery/debulking of a pelvic tumor. Ten PET/CT features were identified and evaluated as predictors of cytoreduction in 54 patients with advanced ovarian cancer.
Complete cytoreduction (no macroscopic residual disease) was achieved in 35% and optimal cytoreduction (<1 cm residual disease) was achieved in 56%. Using univariate analysis, predictors of incomplete cytoreduction were large bowel mesentery implants (LBMI) (P<0.003), pleural effusion (P<0.009), ascites (P<0.009) and peritoneal carcinosis (P<0.01). LBMI (P<0.03) and ascites (P<0.05) were also predictors of suboptimal cytoreduction. Using multivariate analysis, LBMI was the only independent predictor of incomplete cytoreduction (P=0.004) and no predictor of suboptimal cytoreduction was found.
PET/CT predictors of cytoreduction were found. But they should not be used to withhold patients form primary cytoreductive surgery. We suggest PET/CT as a supplementary image modality prior to surgery in primary OC patients whenever accurate and comprehensive preoperative evaluation of primary tumor and metastases is desired.
- SourceAvailable from: Daniela Fischerova[Show abstract] [Hide abstract]
ABSTRACT: Precise diagnostics and clinical staging of the illness is the fundamental requirement for optimal treatment of malig- nant tumours, in all of oncology. Clinical staging only based on physical examination is insufficient. Many authors are therefore emphasizing the need for utilizing one of the imaging methods as obligatory during clinical staging. Those are ultrasound (US), computerized tomography (CT), magnetic resonance (MR) a positron emission tomo- graphy (PET). Ultrasound is the principal method in oncogynecology. During suboptimal ultrasound examination other complimentary digital methods are used. It is important to know the capabilities, limits and even the con- traindications of each examination method. Endoscopic methods (cystoscopy, coloscopy) are indicated only after clinical suspicion of infiltration of these organs. Classical methods (intravenous urography (IVU), plain abdominal X-ray, irigography and others) is quite rare during staging. In many cases engaging several diagnostic methods does not affect the therapeutic method and results in unnecessary burden for the patient, time delay for therapy and additional expenses. This project will deal with rational use of modern imaging methods in diagnostics and staging in gynaecology.
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ABSTRACT: Optimal cytoreduction (OCR) remains the gold standard treatment of ovarian cancer. Current radiological imaging has limited sensitivity and specificity in prediction of achieving OCR prior to surgery. This prospective pilot study included 50 patients with advanced ovarian carcinoma. Prior to the main laparotomy, a mini-laparotomy—just large enough to allow a hand in—was performed. A decision was then made as to whether achieving OCR is “possible”, “not possible” or lastly “unsure”. Formal laparotomy then followed. At the end of the formal laparotomy, cytoreduction was regarded as either “optimal” or “suboptimal” based on residual disease. Out of 45 cases where results were deemed suitable for analysis, 27 were regarded as “OCR possible”, out of which OCR was achieved in 24 cases following full laparotomy. Ten were commented upon as “unsure” and only in three cases OCR was feasible. Eight were classed as “OCR not possible” and in none of these OCR was obtained. The only noted complication associated with mini-laparotomy was bleeding in just three cases (6%). The sensitivity, specificity, PPV and NPV of mini-laparotomy were 100%, 73%, 89% and 100%, respectively. However, when “unsure”, only in 30% OCR was achieved. We concluded that mini-laparotomy is a safe, simple and effective technique for predicting feasibility of OCR. This simple technique could obviate the need for full laparotomy in patients who may benefit from neo-adjuvant chemotherapy.Gynecological Surgery 9(2).
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ABSTRACT: Objective To assess site of disease on preoperative computed tomography (CT) to predict surgical debulking in patients with ovarian cancer.DesignTwo-phase retrospective cohort study.SettingWest London Gynaecological Cancer Centre, UK.PopulationWomen with stage 3 or 4, ovarian, fallopian or primary peritoneal cancer undergoing cytoreductive surgery.Methods Preoperative CT images were reviewed by experienced radiologists to assess the presence or absence of disease at predetermined sites. Multivariable stepwise logistic regression models determined sites of disease which were significantly associated with surgical outcomes in the test (n = 111) and validation (n = 70) sets.Main outcome measuresSensitivity and specificity of CT in predicting surgical outcome.ResultsStepwise logistic regression identified that the presence of lung metastasis, pleural effusion, deposits on the large-bowel mesentery and small-bowel mesentery, and infrarenal para-aortic nodes were associated with debulking status. Logistic regression determined a surgical predictive score which was able to significantly predict suboptimal debulking (n = 94, P = 0.0001) with an area under the curve (AUC) of 0.749 (95% confidence interval [95% CI]: 0.652, 0.846) and a sensitivity of 69.2%, specificity of 71.4%, positive predictive value of 75.0% and negative predictive value of 65.2%. These results remained significant in a recent validation set. There was a significant difference in residual disease volume in the test and validation sets (P < 0.001) in keeping with improved optimal debulking rates.Conclusions The presence of disease at some sites on preoperative CT scan is significantly associated with suboptimal debulking and may be an indication for a change in surgical planning.BJOG An International Journal of Obstetrics & Gynaecology 08/2014; · 3.76 Impact Factor