Abstract
A detailed transabdominal and transvaginal ultrasound examination, performed by an expert examiner, could render a similar diagnostic performance to computed tomography for assessing pelvic/abdominal tumor spread disease in women with epithelial ovarian cancer (EOC). This study aimed to describe and assess the feasibility of lung and intercostal upper abdomen ultrasonography as pretreatment imaging of EOC metastases of supradiaphragmatic and subdiaphragmatic areas. A preoperative ultrasound examination of consecutive patients suspected of having EOC was prospectively performed using transvaginal, transabdominal, and intercostal lung and upper abdomen ultrasonography. A surgical-pathological examination was the reference standard to ultrasonography. Among 77 patients with histologically proven EOC, supradiaphragmatic disease was detected in 13 cases: pleural effusions on the right (n = 12) and left (n = 8) sides, nodular lesions on diaphragmatic pleura (n = 9), focal lesion in lung parenchyma (n = 1), and enlarged cardiophrenic lymph nodes (n = 1). Performance (described with area under the curve) of combined transabdominal and intercostal upper abdomen ultrasonography for subdiaphragmatic areas (n = 77) included the right and left diaphragm peritoneum (0.754 and 0.575 respectively), spleen hilum (0.924), hepatic hilum (0.701), and liver and spleen parenchyma (0.993 and 1.0 respectively). It was not possible to evaluate the performance of lung ultrasonography for supradiaphragmatic disease because only some patients had this region surgically explored. Preoperative lung and intercostal upper abdomen ultrasonography performed in patients with EOC can add valuable information for supradiaphragmatic and subdiaphragmatic regions. A reliable reference standard to test method performance is an area of future research. A multidisciplinary approach to ovarian cancer utilizing lung ultrasonography may assist in clinical decision-making.
Highlights
The first-line treatment for primary epithelial ovarian cancer (EOC) is debulking surgery, with the goal of removing all macroscopic disease, followed by adjuvant chemotherapy [1]
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 to primary debulking surgery [4]
In accordance with to recruit participants, number of eligible patients, characteristics of the proposed outcome measure imaging and patients’ clinical data, we suggested management strategies: upfront surgery or and in some cases feasibility studies might involve designing a suitable outcome measure, follow-up diagnostic laparoscopy followed by neoadjuvant chemotherapy
Summary
The first-line treatment for primary epithelial ovarian cancer (EOC) is debulking surgery, with the goal of removing all macroscopic disease, followed by adjuvant chemotherapy [1]. There are two main considerations: first, whether complete cytoreduction is possible; and second, estimation of the risk of major complications when complex surgery is planned. Presumed stage and surgical complexity, together with patient-related and disease-related variables are important to estimate severe postoperative complications after primary debulking surgery [2,3]. 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 to primary debulking surgery [4]. Reliable pre-surgical predictors of resectability would be valuable tools for assigning patients to the best management plans [4]. More reliable imaging tools for the upper abdomen and pleural space would be valuable
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