Department of Radiodiagnosis, South Egypt Cancer Institute, Assiut University.
Department Obstetrics & Gynecology, Women Health Hospital, Assiut University, Assiut, Egypt.
Acad Radiol. 2019 Dec;26(12):1650-1658. doi: 10.1016/j.acra.2019.04.005. Epub 2019 May 14.
The purpose of this study was to compare the accuracy of MDCT and laparoscopy in the prediction of peritoneal carcinomatosis index score. Reproducibility of MDCT interpretation was also assessed.
This prospective study included 85 ovarian cancer patients underwent MDCT and diagnostic laparoscopy before cytoreductive surgery. We calculated the accuracy of diagnostic modalities in the calculation of the peritoneal cancer index score (PCI). Radiologist interobserver agreement was calculated using kappa statistics.
Nine hundred-thirty (84.2%) of the 1105 regions had peritoneal deposits at exploratory laparotomy. Computed tomography (CT) and laparoscopy sensitivity were 94.9%, 98.3%, specificity 86.7%, 80.4%, PPV 97.9 %, 96.8%, NPV 72.2%, 88.8 %, and accuracy 93.8 %, 95.7%, respectively. However, computed tomography (CT) diagnostic performance is less accurate than laparoscopy in pelvic and small intestinal regions; no statistically significant differences were evident regarding total PCI score compared to surgery (p> 0.05). CT and laparoscopy correctly depicted peritoneal carcinomatosis in 88.2%, 90.6% of patients, respectively. Optimal cytoreduction was achieved in 68 (80%) patients.
Both CT and laparoscopy seems to be effective tools for assessment of peritoneal carcinomatosis using the PCI score. Dedicated MDCT protocol with routine use of a standardized PCI form may provide better comprehensive multi-regional analysis that may help surgeons referring patients to the best treatment option. Laparoscopy is a valuable tool in cases with a high risk of suboptimal cytoreduction related to disease extent.
本研究旨在比较 MDCT 和腹腔镜在预测腹膜癌指数（peritoneal carcinomatosis index，PCI）评分方面的准确性。同时评估 MDCT 解读的可重复性。
本前瞻性研究纳入了 85 例卵巢癌患者，这些患者在细胞减灭术前行 MDCT 和诊断性腹腔镜检查。我们计算了这些诊断方式在计算 PCI 评分方面的准确性。使用 Kappa 统计评估了放射科医师的组内一致性。
在剖腹探查术中，930（84.2%）个 1105 个区域存在腹膜沉积物。CT 和腹腔镜的敏感度分别为 94.9%、98.3%，特异度分别为 86.7%、80.4%，PPV 分别为 97.9%、96.8%，NPV 分别为 72.2%、88.8%，准确性分别为 93.8%、95.7%。然而，CT 对盆腔和小肠区域的诊断性能不如腹腔镜准确；与手术相比，总 PCI 评分无统计学差异（p＞0.05）。CT 和腹腔镜分别正确描述了 88.2%和 90.6%的患者的腹膜癌病变。68（80%）例患者获得了最佳减瘤效果。
CT 和腹腔镜似乎都是使用 PCI 评分评估腹膜癌转移的有效工具。采用专门的 MDCT 方案并常规使用标准化的 PCI 表格可能会提供更好的全面多区域分析，从而帮助外科医生为患者选择最佳治疗方案。在与疾病程度相关的减瘤效果不理想风险较高的情况下，腹腔镜是一种有价值的工具。
