Garrett Celine, Sun Louise, Hayler Raymond, Wijayawardana Ruwanthi, Ahmadi Nima, Sarofim Mina, Morris David L
Liver and Peritonectomy Unit, St George Hospital, Gray Street, Kogarah, NSW, 2217, Australia.
Faculty of Medicine & Health, St George and Sutherland Clinical School (University of New South Wales), St George Hospital, Clinical Sciences (WRPitney) Building, Short Street, Kogarah, NSW, 2217, Australia.
World J Surg Oncol. 2025 Apr 11;23(1):138. doi: 10.1186/s12957-025-03775-5.
Repeat cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) (rCRS-HIPEC) has improved the long-term survival of select patients with acceptable perioperative morbidity and mortality. The pattern of peritoneal disease recurrence is critical in determining eligibility for rCRS-HIPEC. This study evaluated the accuracy, sensitivity and specificity of the radiological peritoneal cancer index (PCI) across different imaging modalities in rCRS-HIPEC patients.
This was a retrospective study on patients with peritoneal disease recurrence who underwent rCRS-HIPEC between January 2022 to December 2023. The accuracy, sensitivity, and specificity of the radiological PCI in predicting the surgical PCI was calculated overall and for each imaging modality at each abdominal region.
32 patients were included in this study. The accuracy, sensitivity and specificity of the overall radiological PCI was 63.0%, 30.8% and 79.9%, respectively. Accuracy (67.5 vs. 62.6%) and specificity (84.8% vs. 75.8%) were higher in FDG-PET versus CT. The sensitivities of all imaging modalities were low (CT 34.9%, FDG-PET 33.3%). FDG-PET and CT had high sensitivities in detecting pelvic disease (80% and 87.5%) but low sensitivities in identifying small bowel (25-33.3% for both modalities) and epigastric disease (25% and 0%). For each abdominal region, the difference between radiological and surgical PCI did not differ significantly based on imaging modality.
Overall, the radiological PCI has a good specificity in rCRS-HIPEC patients and should be used to guide perioperative decision-making. FDG-PET had superior accuracy and specificity in comparison to CT in detecting peritoneal disease recurrence.
重复肿瘤细胞减灭术（CRS）及热灌注化疗（HIPEC）（rCRS-HIPEC）已改善了部分患者的长期生存率，且围手术期发病率和死亡率可接受。腹膜疾病复发模式对于确定rCRS-HIPEC的适用性至关重要。本研究评估了rCRS-HIPEC患者中不同成像方式下放射学腹膜癌指数（PCI）的准确性、敏感性和特异性。
这是一项对2022年1月至2023年12月期间接受rCRS-HIPEC的腹膜疾病复发患者的回顾性研究。总体上以及针对每个腹部区域的每种成像方式，计算放射学PCI预测手术PCI的准确性、敏感性和特异性。
本研究纳入了32例患者。总体放射学PCI的准确性、敏感性和特异性分别为63.0%、30.8%和79.9%。FDG-PET的准确性（67.5%对62.6%）和特异性（84.8%对75.8%）高于CT。所有成像方式的敏感性均较低（CT为34.9%，FDG-PET为33.3%）。FDG-PET和CT在检测盆腔疾病方面具有较高的敏感性（分别为80%和87.5%），但在识别小肠疾病（两种方式均为25%-33.3%）和上腹部疾病（分别为25%和0%）方面敏感性较低。对于每个腹部区域，基于成像方式的放射学和手术PCI之间的差异无显著差异。
总体而言，放射学PCI在rCRS-HIPEC患者中具有良好的特异性，应用于指导围手术期决策。与CT相比，FDG-PET在检测腹膜疾病复发方面具有更高的准确性和特异性。
