Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
Int J Gynecol Cancer. 2011 Nov;21(8):1391-8. doi: 10.1097/IGC.0b013e31822925c0.
The purpose of the study was to determine the performance of a 64-row multidetector computed tomography (MDCT) in identifying peritoneal metastases in ovarian cancer patients undergoing surgical staging or cytoreduction.
This retrospective study included 76 patients who underwent surgical staging (n = 11) or cytoreduction (n = 65). Patients had MDCT before surgery (mean, 24 [SD, 16.9] days) as well as correlative surgicopathologic data. For the imaging analysis, the peritoneal cavity was divided to 28 segments, which were assessed for absence or presence of disease. Rate of optimal cytoreduction at the time of surgery was recorded. The standard of reference for this study was surgery, unless there was proof of metastasis as assessed by follow-up imaging. Sensitivity and predictive accuracy of CT and surgery compared with the standard of reference were calculated.
The overall sensitivity and accuracy were 81.2% and 94.3% for MDCT and 87.4% and 97.2% for surgery (P = 0.14, P = 0.007), respectively. There was no difference in the detection of lesions 1 cm or greater between MDCT and surgery (89.3% and 84.9%, respectively; P = 0.31); however, MDCT was less sensitive than surgery in detecting disease sites of less than 1 cm (65.5% and 92.3%, respectively; P = 0.001). For the subgroup of patients undergoing cytoreduction after neoadjuvant chemotherapy (NAC) (n = 30), sensitivities for MDCT and surgery were similar (80% and 76.9%, respectively [P = 0.71]). Although sensitivity of CT was not altered by NAC (P = 0.92), there was a significant decrease in sensitivity of surgical assessment after NAC (94% vs 76.9%; P = 0.003).
Multidetector computed tomography (MDCT) has similar sensitivity as surgery for peritoneal metastases of 1 cm or greater. The maintained sensitivity of MDCT in detecting peritoneal disease after NAC, which is underestimated at surgery, may help surgical planning and may improve optimal cytoreduction rate in this group of patients.
本研究旨在评估 64 排多层螺旋 CT（MDCT）在卵巢癌患者接受手术分期或细胞减灭术时识别腹膜转移方面的性能。
本回顾性研究纳入了 76 例接受手术分期（n=11）或细胞减灭术（n=65）的患者。患者在术前（平均 24[SD，16.9]天）接受 MDCT 检查，并进行了相关的手术病理数据分析。在影像学分析中，将腹膜腔分为 28 个节段，评估有无疾病存在。记录手术时的最佳肿瘤细胞减灭术率。本研究的标准是手术，除非通过随访影像学检查证实有转移。计算 CT 和手术与标准参考值的敏感性和预测准确性。
MDCT 的总体敏感性和准确性分别为 81.2%和 94.3%，手术的敏感性和准确性分别为 87.4%和 97.2%（P=0.14，P=0.007）。MDCT 与手术在检测 1cm 或更大的病变方面没有差异（分别为 89.3%和 84.9%；P=0.31）；然而，MDCT 在检测小于 1cm 的病变部位时的敏感性低于手术（分别为 65.5%和 92.3%；P=0.001）。对于接受新辅助化疗（NAC）后细胞减灭术的患者亚组（n=30），MDCT 和手术的敏感性相似（分别为 80%和 76.9%[P=0.71]）。尽管 NAC 并未改变 CT 的敏感性（P=0.92），但手术评估的敏感性在 NAC 后显著降低（94%比 76.9%；P=0.003）。
MDCT 对于 1cm 或更大的腹膜转移具有与手术相似的敏感性。在 NAC 后，MDCT 对腹膜疾病的检测敏感性保持不变，而手术对其的评估敏感性降低，这可能有助于手术计划，并可能提高这组患者的最佳肿瘤细胞减灭术率。
