Imaging diagnostics in ovarian cancer: magnetic resonance imaging and a scoring system guiding choice of primary treatment. (March 2017)

• Record Type: Journal Article
• Authors: Kasper, Sigrid M.; Dueholm, Margit; Marinovskij, Edvard; Blaakær, Jan
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 210(2017)
• Page Start: 83
• Page End: 89
• Publication Date: 2017-03
• Subjects: ASA American Society of Anesthesiologists. Referring to the co-morbidities scoring index -- AUC area under curve -- BMI body mass index (BMI) -- Ca125 cancer antigen 125 -- CT computed tomography -- DWI diffusion-weighted imaging -- FDG-Pet fluordeoxyglucose-positron emissions topography -- LHRs likelihood ratio -- MRI magnetic resonance imaging -- NPV negative predictive value -- OC ovarian cancer -- ORs odds ratios -- PCI peritoneal cancer index -- PPC primary peritoneal cancer -- PPV positive predictive value; Ovarian cancer -- Choice of treatment -- Imaging diagnostics -- MRI preoperative staging -- Scoring system; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2016.10.034
• Languages: English
• ISSNs: 0301-2115

Abstract

Abstract: Objective: To analyze the ability of magnetic resonance imaging (MRI) and systematic evaluation at surgery to predict optimal cytoreduction in primary advanced ovarian cancer and to develop a preoperative scoring system for cancer staging. Study design: Preoperative MRI and standard laparotomy were performed in 99 women with either ovarian or primary peritoneal cancer. Using univariate and multivariate logistic regression analysis of a systematic description of the tumor in nine abdominal compartments obtained by MRI and during surgery plus clinical parameters, a scoring system was designed that predicted non-optimal cytoreduction. Results: Non-optimal cytoreduction at operation was predicted by the following: (A) presence of comorbidities group 3 or 4 (ASA); (B) tumor presence in multiple numbers of different compartments, and (C) numbers of specified sites of organ involvement. The score includes: number of compartments involved (1–9 points), >1 subdiaphragmal location with presence of tumor (1 point); deep organ involvement of liver (1 point), porta hepatis (1 point), spleen (1 point), mesentery/vessel (1 point), cecum/ileocecal (1 point), rectum/vessels (1 point): ASA groups 3 and 4 (2 points). Use of the scoring system based on operative findings gave an area under the curve (AUC) of 91% (85–98%) for patients in whom optimal cytoreduction could not be achieved. The score AUC obtained by MRI was 84% (76–92%), and 43% of non-optimal cytoreduction patients were identified, with only 8% of potentially operable patients being falsely evaluated as suitable for non-optimal cytoreduction at the most optimal cut-off value. Tumor in individual locations did not predict operability. Conclusion: This systematic scoring system based on operative findings and MRI may predict non-optimal cytoreduction. MRI is able to assess ovarian cancer with peritoneal carcinomatosis with satisfactory concordance with laparotomic findings. This scoring system could be useful as a clinical guideline and should be evaluated and developed further in larger studies.