Fallon Eleanor A, Awiwi Muhammad O, Bhutiani Neal, Helmink Beth, Scally Chris P, Mansfield Paul, Fournier Keith, Vikram Raghunandan, Uppal Abhineet, White Michael G
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Radiology, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Ann Surg Oncol. 2025 Apr;32(4):2923-2931. doi: 10.1245/s10434-024-16737-0. Epub 2024 Dec 27.
The Peritoneal Cancer Index (PCI), calculated intraoperatively, has previously yielded mixed results when correlated with computed tomography. This study aimed to quantify variation in this scoring method comparing radiologists' and surgeons' radiologic PCI (rPCI) assessment.
The rPCI of 104 patients treated at a single institution for peritoneal carcinomatosis was calculated by an abdominal radiologist and a surgeon. An additional 36-patient cohort was studied to compare preoperative rPCI with intraoperative gold standard PCI. Agreement was compared using kappa statistics.
The rPCI of the 104 patients studied ranged from 2 to 39 (median, 12; interquartile range [IQR], 6-23) by the radiologist's analysis and 2 to 37 (median, 9; IQR, 6-15) by the surgeon's analysis. There was good agreement for PCI cutoffs of 15 (77.48%; kappa, 0.40) and 20 (78.63%; kappa, 0.24). The 36-patient cohort undergoing surgical exploration showed a median rPCI of 4 (IQR, 2-5.75) and a median intraoperative PCI of 11 (IQR, 6-12), with a significant difference in score by method (p < 0.001, Wilcoxon signed-rank test).
For rPCI cutoffs greater than 15 and 20, the surgeon's and radiologist's rPCI showed strong concordance, denoting the interobserver reproducibility of rPCI. Moreover, concordance with intraoperative PCI translated to radiographic assessment. The rPCI consistently underestimated intraoperative PCI, suggesting that rPCI may be a useful conservative tool for assessing peritoneal burden. Although surgical exploration is needed to "rule in" patients as candidates for CRS, the authors suggest that rPCI can be used to "rule out" patients as CRS candidates based on institutional PCI cutoffs.
术中计算的腹膜癌指数（PCI）与计算机断层扫描相关时，此前结果不一。本研究旨在量化这种评分方法在放射科医生和外科医生的放射学PCI（rPCI）评估中的差异。
由一名腹部放射科医生和一名外科医生计算在单一机构接受腹膜癌病治疗的104例患者的rPCI。另外研究了一个36例患者的队列，以比较术前rPCI与术中金标准PCI。使用kappa统计量比较一致性。
经放射科医生分析，所研究的104例患者的rPCI范围为2至39（中位数为12；四分位间距[IQR]为6 - 23），经外科医生分析为2至37（中位数为9；IQR为6 - 15）。PCI临界值为15（77.48%；kappa值为0.40）和20（78.63%；kappa值为0.24）时一致性良好。接受手术探查的36例患者队列的rPCI中位数为4（IQR为2 - 5.75），术中PCI中位数为11（IQR为6 - 12），两种方法的评分有显著差异（p < 0.001，Wilcoxon符号秩检验）。
对于大于15和20的rPCI临界值，外科医生和放射科医生的rPCI显示出很强的一致性，表明rPCI具有观察者间的可重复性。此外，与术中PCI的一致性转化为影像学评估。rPCI始终低估术中PCI，提示rPCI可能是评估腹膜负荷的一种有用的保守工具。虽然需要手术探查来“确定”患者是否为CRS（细胞减灭术）候选者，但作者建议rPCI可用于根据机构PCI临界值“排除”患者作为CRS候选者。
