Pretreatment CT differential diagnosis of tuberculous peritonitis from peritoneal carcinomatosis of advanced epithelial ovarian cancer

Abstract

Delayed diagnosis of female genital tuberculosis (FGTB) can lead to inappropriate treatment and unnecessary surgical procedures rather than standard anti-TB medication. We tried to evaluate the use of computed tomography (CT) imaging to differentiate TB peritonitis from peritoneal carcinomatosis of advanced epithelial ovarian cancer (AEOC). We investigated women who underwent CT to distinguish between TB peritonitis and peritoneal carcinomatosis of AEOC. We evaluated various CT imaging features to identify differences between the two diseases. In addition, we performed univariate and multivariate logistic regression analyses to identify the independent imaging parameters associated with TB peritonitis and evaluated the diagnostic performance of the combined imaging parameters. We also performed the histopathological analysis of the available salpinx specimens of TB peritonitis. We included 25 women with TB peritonitis and 34 women with peritoneal carcinomatosis of AEOC. A multivariate analysis of the discriminant CT imaging features between the two diseases revealed that changes in fallopian tubes and peritoneal micronodules were independent parameters associated with TB peritonitis (p ≤ 0.012). Combining the two imaging parameters showed an area under the receiver operating characteristic curve of 0.855, a sensitivity of 88.0%, and a specificity of 67.7% for differentiating TB peritonitis from peritoneal carcinomatosis. Furthermore, changes in fallopian tubes were correlated with histopathological abnormalities in salpinx specimens. Pretreatment CT evaluation with useful imaging features could help differentiate TB peritonitis from peritoneal carcinomatosis of AEOC.

Enduring Dilemmas in Gastroenterology

“…The authors suggest that combining imaging and clinical features may be more helpful in achieving an accurate diagnosis rather than either alone. This report adds to a plethora of similar reports that suggest that, beyond a point, these findings may not help in achieving a conclusive diagnosis [ 10 , 11 , 12 , 13 , 14 ]. It remains to be seen whether the addition of upcoming armamentaria, like perfusion CT, or an even better application of simple techniques like intestinal bowel ultrasound would help in improving the differentiating ability [ 15 , 16 ].…”

ED diagnosis of peritoneal carcinomatosis

“…CT findings suggestive of peritoneal TB rather than carcinomatosis include loculated ascites, splenomegaly, and lymph node conglomeration, while focal hepatic and nodular omental lesions favor carcinomatosis [11]. A multivariate model [15] and texture analysis [16] have also been used to differentiate these two entities.…”