Preoperative evaluation of Computed Tomography (CT) in patients with peritoneal carcinomatosis (PC) with the recognized Peritoneal Cancer Index (PCI)

Abstract

Ziele: PCI has been recognized as an independent prognostic indicator and as a utility of preoperative CT in assessing Sugarbaker's PCI. This study aimed at evaluating whether CT is an effective procedure for preoperative staging of patients with PC. Methode: Sample of 37 patients, 23 female, 14 male (median: 66yrs) underwent contrast enhanced abdominal CT, followed by surgical staging between 2009 and 2010. CT and surgical findings were analyzed by dividing the abdomen into 9 and small bowel into 4 regions. All CT scans were evaluated 3 times by 2 radiologists with one radiologist reviewing twice. The efficacy of CT was evaluated by comparing radiological with surgical PCIs and quantified by using Spearman's correlation coefficient. Correlations were analysed by abdominopelvic region to assess results for PCIs aggregating the 13 regions. Surgical findings were grouped by lesion size (LS) and compared to radiological findings. Ergebnis: Results indicate high correlation between the radiological and surgical PCIs (r of 0.922 and 0.905, p<0.001). Analyses of the intra-class correlation between the 1st and 2nd review of one radiologist indicate high intra-observer reliability (ICC=0.909, p<0.001). Correlations by abdominopelvic region show higher values in the upper and middle regions (r between 0.660 and 0.881) and relatively lower values in the lower region and small bowel (r between 0.418 and 0.726, p<0.010). Observations by LS from 0 to 3 show increasing sensitivities from 74% (LS 1) to 90% (LS 3). Accuracy of observations decrease from 84% (LS 0) to 34% (LS 3). Schlussfolgerung: CT represents an effective procedure in the preoperative staging of patients with PC. However, results by abdominopelvic region show lower correlation, therefore lower efficacy, and hence underpin an aggregation effect of PCI. These results are supported by analyses of sensitivity and accuracy by LS. This suggests that CT is an effective procedure for pre-operative staging but less for determining a tumor's accurate extent.