Department of Surgical Oncology, St Agnes Hospital, Baltimore, Maryland 21229, USA.
J Surg Oncol. 2010 Nov 1;102(6):565-70. doi: 10.1002/jso.21601.
Evaluation of peritoneal metastases by computed tomography (CT) scans is challenging and has been reported to be inaccurate.
A multi-institutional prospective observational registry study of patients with peritoneal carcinomatosis from colorectal cancer was conducted and a subset analysis was performed to examine peritoneal cancer index (PCI) based on CT and intraoperative exploration.
Fifty-two patients (mean age 52.6 ± 12.4 years) from 16 institutions were included in this study. Inaccuracies of CT-based assessment of lesion sizes were observed in the RUQ (P = 0.004), LLQ (P < 0.0005), RLQ (P = 0.003), distal jejunum (P = 0.004), and distal ileum (P < 0.0005). When CT-PCI was classified based on the extent of carcinomatosis, 17 cases (33%) were underestimations, of which, 11 cases (21%) were upstaged from low to moderate, 4 cases (8%) were upstaged from low to severe, and 2 cases (4%) were upstaged from moderate to severe. Relevant clinical discordance where an upstage occurred to severe carcinomatosis constituted a true inaccuracy and was observed in six cases (12%).
The actual clinical impact of inaccuracies of CT-PCI was modest. CT-PCI will remain as a mandatory imaging tool and may be supplemented with other tools including positron emission tomography scan or diagnostic laparoscopy, in the patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
计算机断层扫描（CT）扫描评估腹膜转移具有挑战性，且已有报道称其评估结果不够准确。
对来自结直肠癌的腹膜癌患者进行了一项多机构前瞻性观察性注册研究，并进行了亚组分析，以检查基于 CT 和术中探查的腹膜癌症指数（PCI）。
本研究纳入了来自 16 个机构的 52 名患者（平均年龄 52.6 ± 12.4 岁）。在 RUQ（P = 0.004）、LLQ（P < 0.0005）、RLQ（P = 0.003）、远端空肠（P = 0.004）和远端回肠（P < 0.0005）处，观察到 CT 评估病变大小的不准确性。当根据肿瘤扩散程度对 CT-PCI 进行分类时，有 17 例（33%）被低估，其中 11 例（21%）从轻度上调为中度，4 例（8%）从轻度上调为重度，2 例（4%）从中度上调为重度。6 例（12%）出现严重程度上调的临床相关不准确性构成真正的不准确。
CT-PCI 不准确性的实际临床影响有限。CT-PCI 将仍然是一种强制性的影像学工具，并可能与其他工具（包括正电子发射断层扫描或诊断性腹腔镜检查）一起用于选择细胞减灭术和腹腔内热灌注化疗的患者。
