Abstract
The aim of this study was to test the accuracy of ultrasonography performed by gynecological oncologists for the preoperative assessment of epithelial ovarian cancer (EOC) spread in the pelvis and abdominal cavity. A prospective, observational cohort study was performed at a single tertiary cancer care unit. Patients with suspected EOC were recruited and underwent comprehensive transvaginal and abdominal ultrasonography performed by a gynecological oncologist. Sixteen intra-abdominal localizations and parameters were assessed using ultrasonography and compared with surgical-pathological status (reference standard). Sensitivity, specificity, positive and negative predictive values, and overall accuracy were calculated. Differences were analyzed using Fisher’s exact and chi-square tests. Ultimately, we included 132 patients (median age 62 years), of whom 67% were in stage IIIC–IVB and 72% had serous cancer. Overall prediction accuracies for the involvement of the omentum, small bowel mesentery root, and frozen pelvis, and detecting ascites were >90%. Detecting the involvement of the pelvis peritoneum, liver and spleen hilum, and rectosigmoid colon, and predictions of disease stage and residual disease had overall accuracies of 80–90%. The lowest accuracy was for involvement of the abdominal peritoneum (69%) and diaphragm peritoneum (right 71%; left 75%) and surgical complexity prediction (77%). Stratification of results by presence or absence of ascites revealed significantly higher specificity of ultrasonography (clinically meaningful) for assessments of the abdominal/pelvic peritoneum, spleen hilum, and rectum wall, if there were ascites. A gynecological oncologist, experienced in surgery and sonology, performing comprehensive ultrasonography on patients with EOC can accurately detect intraperitoneal lesions and recognize critical disease manifestations and predict stage, surgical complexity, and residual disease, which allow accurate qualification of patients for primary debulking surgery or neoadjuvant chemotherapy.
Highlights
Epithelial ovarian cancer (EOC) is the leading cause of death among all gynecological cancers in developed countries, with most patients presenting with advanced-stage tumors, which are defined by the spread of the disease outside the pelvis (International Federation of Obstetrics and Gynecology (FIGO) stages III and IV—more than two-thirds of patients at diagnosis) [1]
The aim of the present study was to test the accuracy of ultrasonography performed by gynecological oncologists for the preoperative assessment of epithelial ovarian cancer (EOC) spread in the pelvis and abdominal cavity
We found that ultrasonography is highly accurate in detecting disease in various anatomical areas, including crucial regions such as the small bowel mesentery root, and in predicting disease stage, surgical complexity, and residual disease
Summary
Epithelial ovarian cancer (EOC) is the leading cause of death among all gynecological cancers in developed countries, with most patients presenting with advanced-stage tumors, which are defined by the spread of the disease outside the pelvis (International Federation of Obstetrics and Gynecology (FIGO) stages III and IV—more than two-thirds of patients at diagnosis) [1]. Primary cytoreduction is reasonable in patients with predicted complete cytoreduction (removing all macroscopic disease) and estimated low risk of surgical complications. For advanced EOC, where resection to residual disease of 1 cm or less is unlikely or the risk of complication is high, neoadjuvant chemotherapy and interval debulking surgery are associated with improved survival and reduced perioperative morbidity compared with those of primary debulking surgery (PDS) [3]. Clinical procedures should be tailored to each patient with EOC and depend on possibilities of complete cytoreduction, surgical skills and experience of the physician, institution infrastructure, and patient characteristics [4]
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