BACKGROUND: The aim was to evaluate the performance of the Peritoneal Cancer Index (PCI) using imaging (ultrasound, contrast-enhanced computed tomography (CT), and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) in assessing peritoneal carcinomatosis and predicting non-resectability in tubo-ovarian carcinoma patients. METHODS: This was a prospective multicenter observational study. We considered all patients with suspected primary ovarian/tubal/peritoneal cancer who underwent preoperative ultrasound, CT, and WB-DWI/MRI (if available). The optimal cut off value for assessing the performance of the methods in predicting non-resectability was identified at the point at which the sensitivity and specificity were most similar. The reference standard to predict non-resectability was surgical outcome in terms of residual disease >1 cm or surgery not feasible. Agreement between imaging methods and surgical exploration in assessing sites included in the PCI score was evaluated using the Intraclass Correlation Coefficient (ICC). RESULTS: 242 patients were included from January 2020 until November 2022. The optimal PCI cut-off for predicting non-resectability for surgical exploration was >12, which achieved the best AUC of 0.87, followed by ultrasound with a cut-off of >10 and AUC of 0.81, WB-DWI/MRI with a cut-off of >12 and AUC of 0.81, and CT with a cut-off of >11 and AUC of 0.74. Using ICC, ultrasound had very high agreement (0.94) with surgical PCI, while CT and WB-DWI/MRI had high agreement (0.86 and 0.87, respectively). CONCLUSION: Ultrasound performed by an expert operator had the best agreement with surgical findings compared to WB-DWI/MRI and CT in assessing radiological PCI. In predicting non-resectability, ultrasound was non-inferior to CT, while its non-inferiority to WB-DWI/MRI was not demonstrated.

Department of Gynecologic Oncology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy

Department of Gynecology Portuguese Institute of Oncology of Lisbon Francisco Gentil Lisbon Portugal; 1st Faculty of Medicine Charles University and General University Hospital Prague

Department of Obstetrics and Gynecology Clínica Universidad de Navarra Pamplona Spain

Department of Radiology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Radiology IRCCS Fondazione Istituto Nazionale dei Tumori di Milano Milan Italy

Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia Fondazione Policlinico Universitario A Gemelli IRCCS Rome Italy

Division of Radiology IEO European Institute of Oncology IRCCS Milan Italy

Fondazione Policlinico Universitario Agostino Gemelli IRCCS Dipartimento Scienze della Salute della Donna del Bambino e di Sanità Pubblica Rome Italy

Gynecologic Oncology Centre Department of Gynecology Obstetrics and Neonatology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic

Preventive Gynecology Unit Division of Gynecology European Institute of Oncology IRCCS Milan Italy

QuironSalud Hospital Málaga Spain; Department of Obstetrics and Gynecology Clínica Universidad de Navarra Pamplona Spain

Citace poskytuje Crossref.org