Pre-operative assessment of intra-abdominal disease spread in epithelial ovarian cancer: a comparative study between ultrasound and computed tomography

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.

Diagnostic Value of Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and Positron Emission Tomography (PET) in the Detection of Lymph Node Metastases in Gynaecologic Cancers

“…If peritoneal carcinomatosis is secondary to an ovarian carcinoma, CT is more accurate than PET-CT in the detection of peritoneal implants [22]. A recent prospective study in which 93 patients diagnosed with ovarian epithelial cancer were included and in which the accuracy of vaginal and abdominal ultrasound compared to CT was evaluated, concluded that the detailed ultrasound examination of the abdominal cavity is so valid for the diagnosis of tumour extension as CT [23].…”

Lung and Intercostal Upper Abdomen Ultrasonography for Staging Patients with Ovarian Cancer: A Method Description and Feasibility Study

“…After excluding patients with FIGO disease stages I and IIA (n = 6) and those who underwent diagnostic laparoscopy because of poor performance status or comorbidities (n = 6), complete (R0) and optimal (R < 1 cm) cytoreduction was achieved in 40 (61%) and 7 (11%) patients, respectively. Median time from the ultrasound examination to surgery was 5 days (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. All patients expressed their willingness to undergo the additional lung and intercostal upper abdomen ultrasound examination, and there were no technical problems associated with this procedure.…”

“…Ultrasonography performed by an expert examiner might be a useful strategy for staging and treatment planning [9][10][11]. Recently, it was shown that a detailed transabdominal and transvaginal ultrasound examination, performed by an expert examiner, could render a similar diagnostic performance to CT for assessing pelvic/abdominal tumor spread disease in women with EOC [11]. Lung ultrasonography is a recognized imaging modality that can be successfully used in many conditions including cancer [12,13].…”

Importance of Surgical Treatment in Ovarian Neoplasm

“…In a study published at the beginning of 2019, in which the sensitivity of the detection of the disease stage following the ultrasound versus the computed tomography was monitored, it was found that the detection rate of the stage of the disease for the ultrasound was 71% compared to 75% for the tomography. [3].…”