1
|
Zhao X, Yang P, Liu L, Li Y, Huang Y, Tang H, Zhou Y, Mao Y. Optimal debulking surgery in ovarian cancer patients: MRI may predict the necessity of rectosigmoid resection. Insights Imaging 2024; 15:145. [PMID: 38886313 PMCID: PMC11183003 DOI: 10.1186/s13244-024-01725-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES To determine whether MRI can predict the necessity of rectosigmoid resection (RR) for optimal debulking surgery (ODS) in ovarian cancer (OC) patients and to compare the predictive accuracy of pre- and post-neoadjuvant chemotherapy (NACT) MRI. METHODS The MRI of 82 OC were retrospectively analyzed, including six bowel signs (length, transverse axis, thickness, circumference, muscularis involvement, and submucosal edema) and four para-intestinal signs (vaginal, parametrial, ureteral, and sacro-recto-genital septum involvement). The parameters reflecting the degree of muscularis involvement were measured. Patients were divided into non-RR and RR groups based on the operation and postoperative outcomes. The independent predictors of the need for RR were identified by multivariate logistic regression analysis. RESULTS Imaging for 82 patients was evaluated (67 without and 15 with NACT). Submucosal edema and muscularis involvement (OR 13.33 and 8.40, respectively) were independent predictors of the need for RR, with sensitivities of 83.3% and 94.4% and specificities of 93.9% and 81.6%, respectively. Among the parameters reflecting the degree of muscularis involvement, circumference ≥ 3/12 had the highest prediction accuracy, increasing the specificity from 81.6% for muscularis involvement only to 98.0%, with only a slight decrease in sensitivity (from 94.4% to 88.9%). The predictive sensitivities of pre-NACT and post-NACT MRI were 100.0% and 12.5%, respectively, and the specificities were 85.7% and 100.0%, respectively. CONCLUSIONS MRI analysis of rectosigmoid muscularis involvement and its circumference can help predict the necessity of RR in OC patients, and pre-NACT MRI may be more suitable for evaluation. CRITICAL RELEVANCE STATEMENT We analyzed preoperative pelvic MRI in OC patients. Our findings suggest that MRI has predictive potential for identifying patients who require RR to achieve ODS. KEY POINTS The need for RR must be determined to optimize treatment for OC patients. Muscularis involvement circumference ≥ 3/12 could help predict RR. Pre-NACT MRI may be superior to post-NACT MRI in predicting RR.
Collapse
Affiliation(s)
- Xiaofang Zhao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Yang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liu Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Huang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huali Tang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yin Zhou
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Yun Mao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
2
|
Antil N, Wang H, Kaffas AE, Desser TS, Folkins A, Longacre T, Berek J, Lutz AM. In Vivo Ultrasound Molecular Imaging in the Evaluation of Complex Ovarian Masses: A Practical Guide to Correlation with Ex Vivo Immunohistochemistry. Adv Biol (Weinh) 2023; 7:e2300091. [PMID: 37403275 DOI: 10.1002/adbi.202300091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/22/2023] [Indexed: 07/06/2023]
Abstract
Ovarian cancer is the fifth leading cause of cancer-related deaths in women and the most lethal gynecologic cancer. It is curable when discovered at an early stage, but usually remains asymptomatic until advanced stages. It is crucial to diagnose the disease before it metastasizes to distant organs for optimal patient management. Conventional transvaginal ultrasound imaging offers limited sensitivity and specificity in the ovarian cancer detection. With molecularly targeted ligands addressing targets, such as kinase insert domain receptor (KDR), attached to contrast microbubbles, ultrasound molecular imaging (USMI) can be used to detect, characterize and monitor ovarian cancer at a molecular level. In this article, the authors propose a standardized protocol is proposed for the accurate correlation between in- vivo transvaginal KDR-targeted USMI and ex vivo histology and immunohistochemistry in clinical translational studies. The detailed procedures of in vivo USMI and ex vivo immunohistochemistry are described for four molecular markers, CD31 and KDR with a focus on how to enable the accurate correlation between in vivo imaging findings and ex vivo expression of the molecular markers, even if not the entire tumor could can be imaged by USMI, which is not an uncommon scenario in clinical translational studies. This work aims to enhance the workflow and the accuracy of characterization of ovarian masses on transvaginal USMI using histology and immunohistochemistry as reference standards, which involves sonographers, radiologists, surgeons, and pathologists in a highly collaborative research effort of USMI in cancer.
Collapse
Affiliation(s)
- Neha Antil
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Huaijun Wang
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Ahmed El Kaffas
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Terry S Desser
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Ann Folkins
- Department of Pathology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Teri Longacre
- Department of Pathology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Jonathan Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Amelie M Lutz
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| |
Collapse
|
3
|
Foster KI, Handley KF, Glassman D, Sims TT, Javadi S, Palmquist SM, Saleh MM, Fellman BM, Fleming ND, Bhosale PR, Sood AK. Characterizing morphologic subtypes of high-grade serous ovarian cancer by CT: a retrospective cohort study. Int J Gynecol Cancer 2023:ijgc-2022-004206. [PMID: 36948527 DOI: 10.1136/ijgc-2022-004206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVE A novel classification system of high-grade serous ovarian carcinoma based on gross morphology observed at pre-treatment laparoscopy was recently defined. The purpose of this study was to identify radiographic features unique to each morphologic subtype. METHODS This retrospective study included 109 patients with high-grade serous ovarian cancer who underwent pre-operative computed tomography (CT) scanning and laparoscopic assessment of disease burden between 1 April 2013 and 5 August 2015. Gross morphologic subtype had been previously assigned by laparoscopy. Two radiologists independently reviewed CT images for each patient, categorized disease at eight anatomic sites, and assessed for radiographic characteristics of interest: large infiltrative plaques, mass-like metastases, enhancing peritoneal lining, architectural distortion, fat stranding, calcifications, and lymph node involvement. Demographic and clinical information was summarized with descriptive statistics and compared using Student's t-tests, χ² tests, or Fisher exact tests as appropriate; kappa statistics were used to assess inter-reader agreement. RESULTS Certain radiographic features were found to be associated with gross morphologic subtype. Large infiltrative plaques were more common in type 1 disease (88.7% (47/53) vs 71.4% (25/35), p=0.04), while mass-like metastases were more often present in type 2 disease (48.6% (17/35) vs 22.6% (12/53), p=0.01). Additionally, radiographic presence of disease at the falciform ligament was more common in type 1 morphology (33.9% (19/56) vs 13.2% (5/38), p=0.02). CONCLUSION Morphologic subtypes of high-grade serous ovarian cancer were associated with specific CT findings, including the presence of large infiltrative plaques, mass-like metastases, and falciform ligament involvement.
Collapse
Affiliation(s)
- Katherine I Foster
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Katelyn F Handley
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Division of Gynecologic Oncology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Deanna Glassman
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Travis T Sims
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanaz Javadi
- Department of Diagnostic Radiology - Body Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah M Palmquist
- Abdominal Imaging Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohammed M Saleh
- Abdominal Imaging Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Bryan M Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicole D Fleming
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Priya R Bhosale
- Abdominal Imaging Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anil K Sood
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
4
|
Zhang XM, Zhang XY, Liu YX, Li RN, Li YM, Linghu H. Computed tomographic enterography (CTE) in evaluating bowel involvement in patients with ovarian cancer. Abdom Radiol (NY) 2022; 47:2023-2035. [PMID: 35380247 DOI: 10.1007/s00261-022-03497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the utility of CTE in the evaluation of bowel invasion in patients with primary ovarian, fallopian tube, and peritoneal cancer. METHODS This observational study included 73 patients who received CTE before operation between September 2019 and December 2021. Two radiologists reviewed CTE images, focusing on the sites and depth of bowel involvement. Based on the findings during surgical exploration, we evaluated the diagnostic power, like sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+ LR), and negative likelihood ratio (- LR) of CTE. Additionally, the characteristic images of bowel involvement on CTE corresponding to surgical findings were shown in the study. RESULTS The rate of macroscopic bowel invasion in this cohort was 49.31% (36/73), of which eight patients had small bowel involvement, 17 patients had colon involvement and 27 patients had sigmoid-rectum involvement. CTE detected bowel invasion in the small intestine with a sensitivity, specificity, PPV, NPV, and accuracy of 87.50%, 92.31%, 58.33%, 98.36%, 91.78%; for colon, the statistics were 58.82%, 96.43%, 83.33%, 88.52%, 87.67% and for sigmoid-rectum 62.96%, 82.61%, 68.00%, 79.17%, 75.34%, respectively. CONCLUSION CTE appeared a preferable diagnostic power on the small bowel and colon invasion in patients with primary ovarian, fallopian tube, and peritoneal cancer.
Collapse
Affiliation(s)
- Xiao-Mei Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xin-Yu Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yue-Xi Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ruo-Nan Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yong-Mei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Hua Linghu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| |
Collapse
|
5
|
Michy T, Bernard C, Coll JL, Josserand V. An Orthotopic Murine Model of Peritoneal Carcinomatosis of Ovarian Origin for Intraoperative PDT. Methods Mol Biol 2022; 2451:175-183. [PMID: 35505018 DOI: 10.1007/978-1-0716-2099-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Advanced ovarian cancer is the most serious among gynecological malignancies and is associated with 35% five-year overall survival. Surgery is the first therapeutic indication, and the absence of remaining macroscopic lesions is the most important prognostic factor. However, tumor dissemination over the whole abdominal cavity largely contributes to the difficulty of complete surgical resection. Consequently, any therapeutic approach that may complete surgical resection should improve patient survival. Considering that some sites are not suitable for surgery because of their close location to vital organs, intraoperative photodynamic therapy (ioPDT) appears to be a complementary therapeutic approach to surgery to obtain the lowest residual disease.Relevant in vivo cancer models that closely resemble human ovarian cancer are essential for preclinical research of alternative antitumor therapeutic strategies. Thus, we propose a comprehensive protocol to set up an orthotopic ovarian xenograft in mice leading to peritoneal carcinomatosis that could be harnessed for antitumor therapeutic application and evaluation.
Collapse
Affiliation(s)
- Thierry Michy
- Institute for Advanced Biosciences, University of Grenoble Alpes, INSERM U1209, CNRS UMR5309, Grenoble, France.,CHU Grenoble Alpes, University of Grenoble Alpes, Grenoble, France
| | - Claire Bernard
- Institute for Advanced Biosciences, University of Grenoble Alpes, INSERM U1209, CNRS UMR5309, Grenoble, France.,CHU Grenoble Alpes, University of Grenoble Alpes, Grenoble, France
| | - Jean-Luc Coll
- Institute for Advanced Biosciences, University of Grenoble Alpes, INSERM U1209, CNRS UMR5309, Grenoble, France
| | - Véronique Josserand
- Institute for Advanced Biosciences, University of Grenoble Alpes, INSERM U1209, CNRS UMR5309, Grenoble, France.
| |
Collapse
|
6
|
An H, Chiu KWH, Tse KY, Ngan HYS, Khong PL, Lee EYP. The Value of Contrast-Enhanced CT in the Detection of Residual Disease After Neo-Adjuvant Chemotherapy in Ovarian Cancer. Acad Radiol 2020; 27:951-957. [PMID: 31629627 DOI: 10.1016/j.acra.2019.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/01/2019] [Accepted: 09/10/2019] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the diagnostic performance of contrast-enhanced computed tomography (CT) in predicting residual disease following neo-adjuvant chemotherapy (NACT) in stage III/IV ovarian cancer. MATERIALS AND METHODS This was a retrospective observational cohort study including consecutive patients with primary stage III/IV ovarian cancer who received NACT before interval debulking surgery. CT findings before interval debulking surgerywere correlated with histological/surgical findings. Diagnostic characteristics were calculated on patient-based and lesion-based analyses. False negative results on peritoneal carcinomatosis detection were correlated with lesion size and site. RESULTS On patient-based analysis, CT (n = 58) had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 92.16%, 57.14%, 94.00%, 50.00%, and 87.93%. On lesion-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 63.01%, 73.47%, 82.51%, 50.00%, and 66.51%. False negative results were associated with lesion size (p < 0.001). The diagnostic performance of CT on the detection of peritoneal carcinomatosis was low at the subdiaphragmatic spaces, bowel serosa and mesentery (p < 0.001). CONCLUSION CT had low negative predictive value in determining residual disease following NACT on both patient-based and lesion-based analyses, especially for non-measurable lesions and at the subdiaphragmatic spaces, bowel serosa and mesentery.
Collapse
Affiliation(s)
- He An
- Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, Room 406, Block K, Pok Fu Lam Road, Hong Kong
| | - Keith W H Chiu
- Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, Room 406, Block K, Pok Fu Lam Road, Hong Kong
| | - K Y Tse
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Hextan Y S Ngan
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, Room 406, Block K, Pok Fu Lam Road, Hong Kong
| | - Elaine Y P Lee
- Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, Room 406, Block K, Pok Fu Lam Road, Hong Kong.
| |
Collapse
|
7
|
Verteporfin-Loaded Lipid Nanoparticles Improve Ovarian Cancer Photodynamic Therapy In Vitro and In Vivo. Cancers (Basel) 2019; 11:cancers11111760. [PMID: 31717427 PMCID: PMC6896159 DOI: 10.3390/cancers11111760] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/24/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022] Open
Abstract
Advanced ovarian cancer is the most lethal gynecological cancer, with a high rate of chemoresistance and relapse. Photodynamic therapy offers new prospects for ovarian cancer treatment, but current photosensitizers lack tumor specificity, resulting in low efficacy and significant side-effects. In the present work, the clinically approved photosensitizer verteporfin was encapsulated within nanostructured lipid carriers (NLC) for targeted photodynamic therapy of ovarian cancer. Cellular uptake and phototoxicity of free verteporfin and NLC-verteporfin were studied in vitro in human ovarian cancer cell lines cultured in 2D and 3D-spheroids, and biodistribution and photodynamic therapy were evaluated in vivo in mice. Both molecules were internalized in ovarian cancer cells and strongly inhibited tumor cells viability when exposed to laser light only. In vivo biodistribution and pharmacokinetic studies evidenced a long circulation time of NLC associated with efficient tumor uptake. Administration of 2 mg.kg-1 free verteporfin induced severe phototoxic adverse effects leading to the death of 5 out of 8 mice. In contrast, laser light exposure of tumors after intravenous administration of NLC-verteporfin (8 mg.kg-1) significantly inhibited tumor growth without visible toxicity. NLC-verteporfin thus led to efficient verteporfin vectorization to the tumor site and protection from side-effects, providing promising therapeutic prospects for photodynamic therapy of cancer.
Collapse
|
8
|
Abstract
Although ovarian serous carcinoma is a well-studied human gynecologic malignancy, this high-grade tumor remains fatal. The main purpose of this review is to summarize the accumulated evidence on serous malignant tumors and to clarify the unresolved issues. We discuss the 8 dichotomies of serous carcinoma: high grade versus low grade, ovarian versus extraovarian primary, extrauterine versus uterine primary, sporadic versus hereditary, orthodox versus alternative histology, p53 overexpression versus complete absence of immunophenotype, TP53-mutated versus intact precursor, and therapy responsive versus refractory. In addition, we summarize the molecular classification of high-grade serous carcinoma. This review would lead readers to rapid and parallel developments in understanding high-grade serous carcinoma.
Collapse
|
9
|
Castellani F, Nganga EC, Dumas L, Banerjee S, Rockall AG. Imaging in the pre-operative staging of ovarian cancer. Abdom Radiol (NY) 2019; 44:685-696. [PMID: 30229424 DOI: 10.1007/s00261-018-1779-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The main prognostic factor in ovarian cancer is the stage of disease at diagnosis. The staging system in use (FIGO classification, updated in 2014) is based on the surgical-pathological findings. Although surgical staging is the gold standard in ovarian cancer, the initial patient management depends on the imaging-based pre-surgical staging assessment, in order to identify unresectable or difficult to resect disease. Radiologists need to be aware of the strengths of the available imaging modalities, as well as the imaging pitfalls. Clear understanding of pattern of disease spread and review areas are critical for accurate staging and treatment planning. The current standard of care for pre-surgical staging is CT of the thorax, abdomen, and pelvis. This allows a rapid evaluation of disease extent and is fairly accurate in identifying bulky disease but has definite limitations in assessing the extent of small volume disease and in the confirmation of certain sites of disease beyond the abdomen. Functional MRI has been reported to be superior in detecting small peritoneal deposits. PET/CT may be used as a problem-solving tool in some patients where determination remains unclear, particularly in confirmation of advanced stage beyond the abdomen.
Collapse
Affiliation(s)
- Francesca Castellani
- Department of Diagnostic Radiology, Royal Marsden NHS Foundation Trust, Fulham Rd., London, SW3 6JJ, UK.
- Department of Diagnostic Radiology and Interventional Radiology, Policlinico Tor Vergata, Viale Oxford 81, 00100, Rome, Italy.
| | - Edward C Nganga
- Department of Diagnostic Radiology, Royal Marsden NHS Foundation Trust, Fulham Rd., London, SW3 6JJ, UK
| | - Lucy Dumas
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, Fulham Rd., London, SW3 6JJ, United Kingdom
| | - Susana Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, Fulham Rd., London, SW3 6JJ, United Kingdom
| | - Andrea G Rockall
- Department of Diagnostic Radiology, Royal Marsden NHS Foundation Trust, Fulham Rd., London, SW3 6JJ, UK
- Division of Surgery and Cancer, Imperial College London, London, United Kingdom
| |
Collapse
|
10
|
Alcázar JL, Caparros M, Arraiza M, Mínguez JÁ, Guerriero S, Chiva L, Jurado M. Pre-operative assessment of intra-abdominal disease spread in epithelial ovarian cancer: a comparative study between ultrasound and computed tomography. Int J Gynecol Cancer 2019; 29:227-233. [DOI: 10.1136/ijgc-2018-000066] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 01/13/2023] Open
Abstract
ObjectiveTo compare the diagnostic performance of ultrasound and computed tomography (CT) for detecting pelvic and abdominal tumor spread in women with epithelial ovarian cancer.MethodsAn observational cohort study of 93 patients (mean age 57.6 years) with an ultrasound diagnosis of adnexal mass suspected of malignancy and confirmed histologically as epithelial ovarian cancer was undertaken. In all cases, transvaginal and transabdominal ultrasound as well as CT scans were performed to assess the extent of the disease within the pelvis and abdomen prior to surgery. The exploration was systematic, analyzing 12 anatomical areas. All patients underwent surgical staging and/or cytoreductive surgery with an initial laparoscopy for assessing resectability. The surgical and pathological findings were considered as the 'reference standard'. Sensitivity and specificity of ultrasound and CT scanning were calculated for the different anatomical areas and compared using the McNemar test. Agreement between ultrasound and CT staging and the surgical stage was estimated using the weighted kappa index.ResultsThe tumorous stage was International Federation of Gynecology and Obstetrics (FIGO) stage I in 26 cases, stage II in 11 cases, stage III in 47 cases, and stage IV in nine cases. Excluding stages I and IIA cases (n=30), R0 (no macroscopic residual disease) was achieved in 36 women (62.2%), R1 (macroscopic residual disease <1 cm) was achieved in 13 women (25.0%), and R2 (macroscopic residual disease >1 cm) debulking surgery occurred in three women (5.8%). Eleven patients (11.8%) were considered not suitable for optimal debulking surgery during laparoscopic assessment. Overall sensitivity of ultrasound and CT for detecting disease was 70.3% and 60.1%, respectively, and specificity was 97.8% and 93.7%, respectively. The agreement between radiological stage and surgical stage for ultrasound (kappa index 0.69) and CT (kappa index 0.70) was good for both techniques. Overall accuracy to determine tumor stage was 71% for ultrasound and 75% for CT.ConclusionDetailed ultrasound examination renders a similar diagnostic performance to CT for assessing pelvic/abdominal tumor spread in women with epithelial ovarian cancer.
Collapse
|
11
|
Radiological and Surgical Correlation of Disease Burden in Advanced Ovarian Cancer Using Peritoneal Carcinomatosis Index. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0175-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
12
|
Wallace S, Kumar A, Mc Gree M, Weaver A, Mariani A, Langstraat C, Dowdy S, Bakkum-Gamez J, Cliby W. Efforts at maximal cytoreduction improve survival in ovarian cancer patients, even when complete gross resection is not feasible. Gynecol Oncol 2017; 145:21-26. [DOI: 10.1016/j.ygyno.2017.01.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
|
13
|
Classification of Ovarian Cancer Surgery Facilitates Treatment Decisions in a Gynecological Multidisciplinary Team. Int J Gynecol Cancer 2017; 27:382-389. [DOI: 10.1097/igc.0000000000000876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveProper planning of intervention and care of ovarian cancer surgery is of outmost importance and involves a wide range of personnel at the departments involved. The aim of this study is to evaluate the introduction of an ovarian surgery classification (COVA) system for facilitating multidisciplinary team (MDT) decisions.Materials and MethodsFour hundred eighteen women diagnosed with ovarian cancers (n = 351) or borderline tumors (n = 66) were selected for primary debulking surgery from January 2008 to July 2013. At an MDT meeting, women were allocated into 3 groups named “pre-COVA” 1 to 3 classifying the expected extent of the primary surgery and need for postoperative care. On the basis of the operative procedures performed, women were allocated into 1 of the 3 corresponding COVA 1 to 3 groups. The outcome measure was the predictive value of the pre-COVA score compared with the actual COVA performed.ResultsThe MDT meeting allocated 213 women (51%) to pre-COVA 1, 136 (33%) to pre-COVA 2, and 52 (12%) to pre-COVA 3. At the end of surgery, 168 (40%) were classified as COVA 1, 158 (38%) were classified as COVA 2, and 28 (7%) were classified as COVA 3. Traced individually, 212 (51%) patients were correctly preclassified at the MDT meeting and distributed into 110 (52%) COVA 1, 71 (52%) COVA 2, and 17 (32%) COVA 3. Analyzing the subgroup of patients with cancer, 164 (47%) were correctly preclassified. Regarding the International Federation of Gynecology and Obstetrics (FIGO) stages, the pre-COVA classification predicted the actual COVA group in 79 (49%) FIGO stages I to IIIB and in 85 (45%) FIGO stages IIIC to IV.ConclusionsThe COVA classification system is a simple and useful tool in the MDT setting where specialists make treatment decisions based on advanced technology. The use of pre-COVA classification facilitates well-organized patient care–relevant procedures to be undertaken. Pre-COVA accurately predicts the final COVA in 51% classified women.
Collapse
|
14
|
Lopez-Lopez V, Cascales-Campos P, Gil J, Frutos L, Andrade R, Fuster-Quiñonero M, Feliciangeli E, Gil E, Parrilla P. Use of 18 F-FDG PET/CT in the preoperative evaluation of patients diagnosed with peritoneal carcinomatosis of ovarian origin, candidates to cytoreduction and hipec. A pending issue. Eur J Radiol 2016; 85:1824-1828. [DOI: 10.1016/j.ejrad.2016.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 12/19/2022]
|
15
|
Sharma SK, Nemieboka B, Sala E, Lewis JS, Zeglis BM. Molecular Imaging of Ovarian Cancer. J Nucl Med 2016; 57:827-33. [PMID: 27127223 DOI: 10.2967/jnumed.115.172023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/14/2016] [Indexed: 01/03/2023] Open
Abstract
Ovarian cancer is the most lethal gynecologic malignancy and the fifth leading cause of cancer-related death in women. Over the past decade, medical imaging has played an increasingly valuable role in the diagnosis, staging, and treatment planning of the disease. In this "Focus on Molecular Imaging" review, we seek to provide a brief yet informative survey of the current state of the molecular imaging of ovarian cancer. The article is divided into sections according to modality, covering recent advances in the MR, PET, SPECT, ultrasound, and optical imaging of ovarian cancer. Although primary emphasis is given to clinical studies, preclinical investigations that are particularly innovative and promising are discussed as well. Ultimately, we are hopeful that the combination of technologic innovations, novel imaging probes, and further integration of imaging into clinical protocols will lead to significant improvements in the survival rate for ovarian cancer.
Collapse
Affiliation(s)
- Sai Kiran Sharma
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York Program in Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brandon Nemieboka
- Tri-Institutional MD-PhD Program, New York, New York Gerstner Sloan Kettering Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York Departments of Radiology and Pharmacology, Weill Cornell Medical College, New York, New York
| | - Jason S Lewis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York Program in Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York, New York Gerstner Sloan Kettering Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, New York Departments of Radiology and Pharmacology, Weill Cornell Medical College, New York, New York
| | - Brian M Zeglis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York Departments of Radiology and Pharmacology, Weill Cornell Medical College, New York, New York Department of Chemistry, Hunter College of City University of New York, New York, New York; and Graduate Center of City University of New York, New York, New York
| |
Collapse
|
16
|
Bresson L, Allard-Duclercq C, Narducci F, Tresch E, Lesoin A, Ahmeidi A, Leblanc E. Single-port or Classic Laparoscopy Compared With Laparotomy to Assess the Peritoneal Cancer Index in Primary Advanced Epithelial Ovarian Cancer. J Minim Invasive Gynecol 2016; 23:825-32. [PMID: 27068278 DOI: 10.1016/j.jmig.2016.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 12/16/2022]
Abstract
A thorough laparoscopic assessment of the abdominopelvic cavity is a crucial step in the workup of primary advanced epithelial ovarian cancer to decide whether up-front cytoreductive surgery or neoadjuvant chemotherapy is the best option for adequate management. The purpose of our study was to compare single-port laparoscopy (SPL), classic laparoscopy (CL), and laparotomy using the peritoneal cancer index (PCI). Patients treated for Fédération Internationale de Gynécologie et d'Obstétrique stage 3 or 4 epithelial ovarian cancer were included in our study when they underwent a PCI evaluation by laparoscopy followed by laparotomy for cytoreduction. According to the technique used for the "noninvasive" procedure (SPL vs CL), 2 groups were compared retrospectively. The individual records of all patients were reviewed and analyzed. From 2011 to 2014, 21 patients were assessed for PCI by SPL plus laparotomy versus 21 by CL plus laparotomy. The clinicopathological features were similar in both groups (not significant [NS]), except for performance status >0, which was more frequent in the SPL group (39% vs 6%, p = .04). Quotation of PCI was possible for all patients. Nonbrowsing areas marked 3 procedures in the SPL group and 2 procedures in the CL group (NS). The mean PCI score and the score of each region assessed by SPL and CL were comparable with the evaluation by laparotomy (NS). Completeness of cytoreduction was achieved in 78% of cases in both groups (NS). SPL and widely mini-invasive procedures seem to be effective tools compared with laparotomy to adequately assess the resectability of a peritoneal carcinomatosis using the PCI.
Collapse
Affiliation(s)
- Lucie Bresson
- Department of Gynecologic Oncology, Oscar Lambret Center, Lille Cedex, France.
| | | | - Fabrice Narducci
- Department of Gynecologic Oncology, Oscar Lambret Center, Lille Cedex, France
| | | | - Anne Lesoin
- Department of Gynecologic Oncology, Oscar Lambret Center, Lille Cedex, France
| | - Abesse Ahmeidi
- Department of Anesthesia, Oscar Lambret Center, Lille Cedex, France
| | - Eric Leblanc
- Department of Gynecologic Oncology, Oscar Lambret Center, Lille Cedex, France
| |
Collapse
|
17
|
Kumar A, Janco JM, Mariani A, Bakkum-Gamez JN, Langstraat CL, Weaver AL, McGree ME, Cliby WA. Risk-prediction model of severe postoperative complications after primary debulking surgery for advanced ovarian cancer. Gynecol Oncol 2016; 140:15-21. [DOI: 10.1016/j.ygyno.2015.10.025] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/28/2015] [Accepted: 10/31/2015] [Indexed: 01/31/2023]
|
18
|
Patankar S, Burke WM, Hou JY, Tergas AI, Huang Y, Ananth CV, Neugut AI, Hershman DL, Wright JD. Risk stratification and outcomes of women undergoing surgery for ovarian cancer. Gynecol Oncol 2015; 138:62-9. [PMID: 25976399 PMCID: PMC4469531 DOI: 10.1016/j.ygyno.2015.04.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Cytoreduction for ovarian cancer is associated with substantial morbidity. We examined the outcome of patients undergoing surgery for ovarian cancer to determine if there are sub-groups of patients who may benefit from alternative treatments. METHODS The National Surgical Quality Improvement Program database was used to identify women who underwent surgery for ovarian cancer from 2005-2012. Multivariable logistic regression models were used to examine the effect of age, race, functional status, ASA class, preoperative albumin and performance of extended cytoreductive procedures on morbidity, mortality and resource utilization. RESULTS A total of 2870 women were identified. The perioperative complication rate increased from 9.5% in women <50years, to 13.4% in those age 60-69years, and 14.6% in women ≥70years (P<0.0001). Similarly, complications rose from 7.3% in those who did not require any extended procedures to 12.9% after 1 procedure, 28.4% for those who had 2, and 30.0% in women who underwent ≥3 extended procedures (P<0.0001). In a series of multivariable models, the number of extended cytoreductive procedures performed and preoperative albumin were the factors most consistently associated with morbidity. Using a series of model fit statistics, compared to chance alone, the ability to predict any complication increased by 27.4% when procedure score was analyzed, 22.0% with preoperative albumin, 11% with age, and 4% with functional status. CONCLUSIONS While preoperative clinical and demographic factors may help predict the risk of adverse outcomes for women undergoing surgery for ovarian cancer, performance of extended cytoreductive procedures is the strongest risk factor for complications.
Collapse
Affiliation(s)
- Sonali Patankar
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA
| | - William M Burke
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - June Y Hou
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Ana I Tergas
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA
| | - Alfred I Neugut
- Department of Medicine, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Dawn L Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA.
| |
Collapse
|
19
|
Janco JMT, Glaser G, Kim B, McGree ME, Weaver AL, Cliby WA, Dowdy SC, Bakkum-Gamez JN. Development of a prediction model for residual disease in newly diagnosed advanced ovarian cancer. Gynecol Oncol 2015; 138:70-7. [PMID: 25913130 DOI: 10.1016/j.ygyno.2015.04.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/14/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To construct a tool, using computed tomography (CT) imaging and preoperative clinical variables, to estimate successful primary cytoreduction for advanced epithelial ovarian cancer (EOC). METHODS Women who underwent primary cytoreductive surgery for stage IIIC/IV EOC at Mayo Clinic between 1/2/2003 and 12/30/2011 and had preoperative CT images of the abdomen and pelvis within 90days prior to their surgery available for review were included. CT images were reviewed for large-volume ascites, diffuse peritoneal thickening (DPT), omental cake, lymphadenopathy (LP), and spleen or liver involvement. Preoperative factors included age, body mass index (BMI), Eastern Cooperative Oncology Group performance status (ECOG PS), American Society of Anesthesiologists (ASA) score, albumin, CA-125, and thrombocytosis. Two prediction models were developed to estimate the probability of (i) complete and (ii) suboptimal cytoreduction (residual disease (RD) >1cm) using multivariable logistic analysis with backward and stepwise variable selection methods. Internal validation was assessed using bootstrap resampling to derive an optimism-corrected estimate of the c-index. RESULTS 279 patients met inclusion criteria: 143 had complete cytoreduction, 26 had suboptimal cytoreduction (RD>1cm), and 110 had measurable RD ≤1cm. On multivariable analysis, age, absence of ascites, omental cake, and DPT on CT imaging independently predicted complete cytoreduction (c-index=0.748). Conversely, predictors of suboptimal cytoreduction were ECOG PS, DPT, and LP on preoperative CT imaging (c-index=0.685). CONCLUSIONS The generated models serve as preoperative evaluation tools that may improve counseling and selection for primary surgery, but need to be externally validated.
Collapse
Affiliation(s)
| | | | - Bohyun Kim
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - William A Cliby
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sean C Dowdy
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
20
|
Romero-Laorden N, Olmos D, Fehm T, Garcia-Donas J, Diaz-Padilla I. Circulating and disseminated tumor cells in ovarian cancer: a systematic review. Gynecol Oncol 2014; 133:632-9. [PMID: 24657303 DOI: 10.1016/j.ygyno.2014.03.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 03/06/2014] [Accepted: 03/09/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Detecting circulating tumor cells (CTCs) in the peripheral blood and disseminated tumor cells (DTCs) in the bone marrow of cancer patients has proven feasible and of prognostic value in different neoplasms. However, the clinical significance of CTCs and DTCs in ovarian cancer and its association with outcome remains unclear. METHODS A literature search in PubMed was performed from January 2000 to December 2013 for studies evaluating CTCs and/or DTCs and its association with clinicopathological characteristics and clinical outcome in ovarian cancer. The main outcome measures were progression-free survival (PFS) and overall survival (OS). RESULTS Fourteen studies met the inclusion criteria. Median study size was 84 patients (range 43-216). Median follow-up was 19months (range 5-52). Most studies were small case series (n<100; studies; 71%). The majority of studies used an immunophenotyping approach to identify CTCs and/or DTCs, but only 3 studies (21%) used the FDA-approved Cell Search method. Despite the differences in methodology among studies the presence of CTCs and DTCs tended to be associated with higher baseline CA-125 serum levels, higher odds of residual disease after surgery, and worse survival in ovarian cancer across studies. No consistent intra-patient correlation was observed between DTCs detected in the bone marrow and CTCs detected in the blood. CONCLUSIONS The presence of CTCs and DTCs is associated with adverse clinicopathological characteristics and poor clinical outcomes in ovarian cancer patients. Its implementation as a valuable prognostic tool in the clinical setting requires uniform methodology and prospective validation.
Collapse
Affiliation(s)
- Nuria Romero-Laorden
- Division of Medical Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario HM Sanchinarro, Madrid, Spain; Clinical Research Program, Centro Nacional de Investigaciones Oncologicas, Madrid, Spain
| | - David Olmos
- Division of Medical Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario HM Sanchinarro, Madrid, Spain; Clinical Research Program, Centro Nacional de Investigaciones Oncologicas, Madrid, Spain
| | - Tanja Fehm
- Department of Obstetrics and Gynecology, University of Düsseldorf, Düsseldorf, Germany
| | - Jesus Garcia-Donas
- Division of Medical Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario HM Sanchinarro, Madrid, Spain; Clinical Research Program, Centro Nacional de Investigaciones Oncologicas, Madrid, Spain
| | - Ivan Diaz-Padilla
- Division of Medical Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario HM Sanchinarro, Madrid, Spain.
| |
Collapse
|
21
|
Walker J. Intraperitoneal chemotherapy requires expertise and should be the standard of care for optimally surgically resected epithelial ovarian cancer patients. Ann Oncol 2013; 24 Suppl 10:x41-45. [DOI: 10.1093/annonc/mdt469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
22
|
Hynninen J, Kemppainen J, Lavonius M, Virtanen J, Matomäki J, Oksa S, Carpén O, Grénman S, Seppänen M, Auranen A. A prospective comparison of integrated FDG-PET/contrast-enhanced CT and contrast-enhanced CT for pretreatment imaging of advanced epithelial ovarian cancer. Gynecol Oncol 2013; 131:389-94. [PMID: 23994535 DOI: 10.1016/j.ygyno.2013.08.023] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/15/2013] [Accepted: 08/22/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The use of tumor debulking surgery in the management of epithelial ovarian cancer (EOC), which is often disseminated in the peritoneal cavity at the time of diagnosis, has a significant impact on prognosis. We compared (18)F-fluorodeoxyglucose (FDG) positron emission tomography/contrast-enhanced computed tomography (PET/CT) to contrast-enhanced CT for the detection of dissemination into the abdominal cavity preventing successful primary debulking surgery. METHODS Forty-one women with EOC underwent preoperative whole-body low-dose FDG-PET/CT followed by diagnostic high dose contrast-enhanced CT scan, and the results were compared with systematically recorded surgical findings as a reference standard. Both site-based and patient-based analyses were conducted. RESULTS FDG-PET/CT was superior to conventional CT for the detection of carcinomatosis in subdiaphragmatic peritoneal surfaces (p=0.020) and in the bowel mesentery (p=0.001). Patient-based analysis of upper abdominal areas requiring extensive surgical procedures showed no significant differences between the two imaging methods. The sensitivity of PET/CT and CT was poor in certain areas of the peritoneal cavity (64% vs. 27% in the small bowel mesentery and 65% vs. 55% in the right upper abdomen). Extra-abdominal disease spread was detected by PET/CT in 32 patients and by CT in 25 patients. CONCLUSIONS PET/CT was not superior to CT for the detection of intra-abdominal disease spread. Patients with suspected EOC should be referred for upfront radical surgery regardless of the results of preoperative imaging studies. PET/CT is more effective for the detection of extra-abdominal disease than CT, but the clinical significance of this finding is unclear.
Collapse
Affiliation(s)
- Johanna Hynninen
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, FI-20520 Turku, Finland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|