The reliability of pre-operative CT imaging in predicting cardiophrenic lymph node involvement prior to both PDS and DDS for advanced ovarian cancer (532)

Abstract

<b>Objectives:</b> Cardiophrenic lymph node (CPLN) involvement represents stage IVB ovarian cancer. Driven by the prognostic importance of complete cytoreduction, the surgical practice has evolved to increasingly incorporate CPLN dissection as a component of ultraradical debulking for advanced disease. We aimed to evaluate the reliability of preoperative imaging in accurately identifying positive CPLN - and hence those patients for whom removal may confer benefit. <b>Methods:</b> Preoperative CT imaging was retrospectively reviewed for all patients undergoing either primary (PDS) or delayed debulking surgery (DDS) for stage III or IV tubo-ovarian / primary peritoneal carcinoma in a UK cancer center between 2017-2020. CPLN measuring >5 millimeters - or those with abnormal morphology (irregular border / absent fatty hilum / heterogeneous internal attenuation) - were deemed radiologically suspicious. For patients within this ‘node-positive' cohort, histology for those having undergone CPLN dissection was also reviewed, and the correlation between imaging and final pathology was analyzed. <b>Results:</b> A total of 141 patients undergoing either PDS or DDS for advanced tubo-ovarian or primary peritoneal cancer were identified. On review of preoperative CT, 60 patients (42.6%) were deemed to have radiologically involved CPLN. Of these, 13 patients had undergone CPLN dissection, with positive histopathology confirming CPLN metastases in 11/13 patients (84.6%). This equates to a positive predictive value (PPV) for CT in identifying this disease entity of 0.846, with no significant difference seen in the context of PDS versus DDS. <b>Conclusions:</b> While our patient numbers are limited, reflecting the introduction of this evolving surgical technique to our center during the timeframe reviewed, our data suggest that preoperative CT is an accurate predictor of CPLN disease in advanced tubo-ovarian / primary peritoneal malignancy in advance of both PDS and DDS and can be reliably used to guide patient selection for CPLN dissection.