Radiological and Surgical Correlation of Disease Burden in Advanced Ovarian Cancer Using Peritoneal Carcinomatosis Index

Abstract

The study aims to identify the accuracy of computed tomography (CT) in preoperative characterization and staging of ovarian cancer using peritoneal carcinomatosis index (PCI) and compare it with the PCI determined at the time of surgery and to see the accuracy in individual abdominopelvic regions. Forty patients with presumed Stage IIIc/IV ovarian cancer were included in the study sample. Tumor localization and size was objectively documented using Sugarbaker’s PCI which divided the entire abdominopelvic region into 13 spaces, scores assigned based on lesion size (LS) and summed up (range 0–39). PCI scoring was first done using CECT (16 slice Siemens Somatom Emotion CT machine). Intra-operative PCI scoring was done during explorative laparotomy following a standard procedure and protocol. There was a statistically significant correlation between the intra-operative and radiological observations which showed Pearson’s correlation coefficient of 0.642. The correlation was more in the middle and lower abdominopelvic regions. The best correlations were seen in right flank with a correlation coefficient of 0.835. The worst assessed areas were right upper (liver and subhepatic area) and lower jejunum. Sensitivity, specificity, PPV and NPV were also assessed for individual areas and found to be significant in most areas. Radiological PCI has a good correlation with surgical PCI and, hence, is useful in predicting patients with potentially unresectable disease. The routine use of a standardized PCI form may lead to a more objective assessment and systematic multi-quadrant analysis and will lead to enhanced patient care and good outcome.