Prediction of suboptimal primary cytoreduction in primary ovarian cancer with combined positron emission tomography/computed tomography—A prospective study

Risum, Signe; Høgdall, Claus; Loft, Annika; Berthelsen, Anne Kiil; Høgdall, Estrid; Nedergaard, Lotte; Lundvall, Lene; Engelholm, Silke

doi:10.1016/j.ygyno.2007.11.002

Cited by 94 publications

(47 citation statements)

References 31 publications

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“…Therefore, as a practical rule, the calculation of the rate of inappropriate unexploration can be carried out from our models, as the inverse of PPV and therefore will be 0% at the cutoff values of 7 and 4, in Models 2 and 4, respectively. Finally, more sophisticated imaging approaches such as Positron emission tomography/computed tomography (PET/CT) (Risum et al, 2008), as well as laparoscopic approaches (LPS) scores (Fagotti et al, 2006(Fagotti et al, , 2008Brun et al, 2008) have been recently investigated in terms of prediction of surgical outcome in advanced ovarian cancer, whereas the results of PET/CT seem currently too preliminary to draw any definitive conclusion, data from pilot and prospective studies proposed open LPS as a reliable and flexible predictive tool scores (Fagotti et al, 2006(Fagotti et al, , 2008Brun et al, 2008). Although the accuracy of LPS in the assessment of specific sites of disease involvement is expectedly higher compared with CT scan (Fagotti et al, 2006(Fagotti et al, , 2008Brun et al, 2008), the clinical impact of whether triaging or not advanced ovarian cancer patients to laparotomy on the basis of LPS findings urgently requires to be investigated in controlled clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial

et al. 2009

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BACKGROUND: In advanced ovarian cancer, maximal efforts have to be attemptedto achieve optimal cytoreduction, as this represents the keystone in the therapeutic management. This large, prospective study aims at investigating the role of computed tomography (CT) scan in predicting the feasibility of optimal cytoreduction in ovarian cancer. METHODS: A total of 195 consecutive patients with clinical/radiographic suspicion of advanced ovarian/peritoneal cancer were enrolled at the Gynecologic Oncology Unit, Catholic University of Rome and Campobasso, Italy. Preoperative CT scans were performed with a high-speed scanner (CT Hi Speed Nx/i Pro; 2-slice; GE Medical System). All patients underwent standard laparotomy, and maximal surgical effort was attempted. The following CT parameters were used: peritoneal thickening, peritoneal implants 42 cm, bowel mesentery involvement, omental cake, pelvic sidewall involvement and/or hydroureter, suprarenal aortic lymph nodes 41 cm, infrarenal aortic lymph nodes 42 cm, superficial liver metastases 42 cm and/or intraparenchimal liver metastases any size, large volume ascites (4500 ml). Clinical data included were age, Ca125 serum levels, and ECOG-PS. Radiographic and clinical features exhibiting a specificity 475%, a positive and negative predictive value 450%, an accuracy 460% in predicting surgical outcome were assigned a point value of 2. With this scoring system, a predictive index (PI) was calculated for each patient. RESULTS: The PI scores ranged from 0 to 6, and from 0 to 8, in Model 1 (including only radiographic parameters) and in Model 2 (including radiographic and clinical data). The AUC was 0.78 þ 0.035 in Model 1, and 0.81 þ 0.031 in Model 2. Therefore, the addition of ECOG-PS data led to the improvement of the diagnostic performances (z ¼ 2.41, P-value o0.05). CONCLUSIONS: Computed scan still represents a valid tool to predict ovarian cancer optimal cytoreduction; the predictive ability of a CT scan-based model is improved by integrating ECOG-PS data.

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Section: Discussionmentioning

confidence: 99%

Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial

et al. 2009

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“…This is in stark contrast to the use of CT scans to predict successful surgical debulking. Several studies have failed to show that CT findings can predict cytoreductive surgery outcomes across centers [10][11][12][13][14][15][16][17]. Subjective interpretation of CT findings and difficulty with standardized definitions have both been cited as minor contributors to this.…”

Section: Introductionmentioning

confidence: 99%

The Use of CT Findings to Predict Extent of Tumor at Primary Surgery for Ovarian Cancer

Glaser

Torres

Kim

et al. 2013

Obstetrical &Amp; Gynecological Survey

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“…In future, it is anticipated that integrated FDG-PET/CT may have a role in assessment of disease spread and decision with regards to best therapeutic strategy in ovarian cancer. FDG-PET/CT has been shown to have a higher sensitivity (91%) than PET, CT or MRI in assessment of disease spread [31,32]. Hence, it may further assist in early identification of patients who are not suitable for up front surgery.…”

Section: Discussionmentioning

confidence: 99%

Mini-laparotomy in advanced ovarian cancer

et al. 2011

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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 minilaparotomy 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.

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Prediction of suboptimal primary cytoreduction in primary ovarian cancer with combined positron emission tomography/computed tomography—A prospective study

Cited by 94 publications

References 31 publications

Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial

Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial

The Use of CT Findings to Predict Extent of Tumor at Primary Surgery for Ovarian Cancer

Mini-laparotomy in advanced ovarian cancer

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