Alcázar Juan Luis, Caparros María, Arraiza Maria, Mínguez José Ángel, Guerriero Stefano, Chiva Luis, Jurado Matías
Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain.
Int J Gynecol Cancer. 2019 Feb;29(2):227-233. doi: 10.1136/ijgc-2018-000066. Epub 2019 Jan 10.
To compare the diagnostic performance of ultrasound and computed tomography (CT) for detecting pelvic and abdominal tumor spread in women with epithelial ovarian cancer.
An observational cohort study of 93 patients (mean age 57.6 years) with an ultrasound diagnosis of adnexal mass suspected of malignancy and confirmed histologically as epithelial ovarian cancer was undertaken. In all cases, transvaginal and transabdominal ultrasound as well as CT scans were performed to assess the extent of the disease within the pelvis and abdomen prior to surgery. The exploration was systematic, analyzing 12 anatomical areas. All patients underwent surgical staging and/or cytoreductive surgery with an initial laparoscopy for assessing resectability. The surgical and pathological findings were considered as the 'reference standard'. Sensitivity and specificity of ultrasound and CT scanning were calculated for the different anatomical areas and compared using the McNemar test. Agreement between ultrasound and CT staging and the surgical stage was estimated using the weighted kappa index.
The tumorous stage was International Federation of Gynecology and Obstetrics (FIGO) stage I in 26 cases, stage II in 11 cases, stage III in 47 cases, and stage IV in nine cases. Excluding stages I and IIA cases (n=30), R0 (no macroscopic residual disease) was achieved in 36 women (62.2%), R1 (macroscopic residual disease <1 cm) was achieved in 13 women (25.0%), and R2 (macroscopic residual disease >1 cm) debulking surgery occurred in three women (5.8%). Eleven patients (11.8%) were considered not suitable for optimal debulking surgery during laparoscopic assessment. Overall sensitivity of ultrasound and CT for detecting disease was 70.3% and 60.1%, respectively, and specificity was 97.8% and 93.7%, respectively. The agreement between radiological stage and surgical stage for ultrasound (kappa index 0.69) and CT (kappa index 0.70) was good for both techniques. Overall accuracy to determine tumor stage was 71% for ultrasound and 75% for CT.
Detailed ultrasound examination renders a similar diagnostic performance to CT for assessing pelvic/abdominal tumor spread in women with epithelial ovarian cancer.
比较超声和计算机断层扫描（CT）在检测上皮性卵巢癌女性盆腔和腹部肿瘤扩散方面的诊断性能。
对93例患者（平均年龄57.6岁）进行了一项观察性队列研究，这些患者经超声诊断为附件包块疑似恶性，并经组织学确诊为上皮性卵巢癌。所有病例在手术前均进行经阴道和经腹超声以及CT扫描，以评估盆腔和腹部疾病的范围。检查是系统性的，分析12个解剖区域。所有患者均接受手术分期和/或减瘤手术，最初通过腹腔镜检查评估可切除性。手术和病理结果被视为“参考标准”。计算超声和CT扫描在不同解剖区域的敏感性和特异性，并使用McNemar检验进行比较。使用加权kappa指数评估超声和CT分期与手术分期之间的一致性。
肿瘤分期为国际妇产科联盟（FIGO）I期的有26例，II期的有11例，III期的有47例，IV期的有9例。排除I期和IIA期病例（n = 30）后，36名女性（62.2%）实现了R0（无肉眼可见残留病灶），13名女性（25.0%）实现了R1（肉眼可见残留病灶<1 cm），3名女性（5.8%）进行了R2（肉眼可见残留病灶>1 cm）减瘤手术。11名患者（11.8%）在腹腔镜评估期间被认为不适合进行最佳减瘤手术。超声和CT检测疾病的总体敏感性分别为70.3%和60.1%，特异性分别为97.8%和93.7%。超声（kappa指数0.69）和CT（kappa指数0.70）的放射学分期与手术分期之间的一致性对于两种技术来说都良好。超声确定肿瘤分期的总体准确率为71%，CT为75%。
详细的超声检查在评估上皮性卵巢癌女性盆腔/腹部肿瘤扩散方面具有与CT相似的诊断性能。
