Tumor Extent In Patients Research Articles

Preoperative Detection of Local Tumor Extent in Patients with Advanced Retinoblastoma: Predictive Value of MRI and Clinical Findings.

Before planned enucleation, local tumor extension in advanced retinoblastoma is routinely assessed preoperatively using high-resolution magnetic resonance imaging (MRI). The aim of our study was to analyse the predictive value of MRI and clinical characteristics for predicting tumor extent, as confirmed by histopathology postoperatively. All consecutive patients were included who underwent primary enucleation for advanced retinoblastoma after high-resolution MRI examination in our hospital between January 2011 and December 2021. The primary study endpoint was the evaluation of the predictability of histopathological risk factors on preoperative MRI examination. The sensitivity and specificity of the MRI examination with respect to clinically relevant optic nerve infiltration and choroidal infiltration were determined. The mean age of the 209 included patients was 1.6years (range 1 month to 4.7 years). MRI indicated optic nerve infiltration in 46 (22%) patients, extensive choroidal infiltration in 78 (40.2%) patients, and scleral infiltration in one patient (2.6%). Histopathological examination demonstrated postlaminar optic infiltration in 25 (12%) patients and extensive choroidal infiltration in 17 (8.1%) cases. Scleral infiltration was evident in 8 (3.8%) patients. In the final multivariate analysis, MRI findings of tumor infiltration and a preoperative intraocular pressure ≥ 20 mmHg were independently associated with histopathological evidence of clinically relevant optic nerve (p = 0.033/p = 0.011) and choroidal infiltration (p = 0.005/p = 0.029). The diagnostic accuracy of the prediction models based on the multivariate analysis for the identification of the clinically relevant optic nerve (AUC = 0.755) and choroidal infiltration (AUC = 0.798) was greater than that of purely MRI-based prediction (respectively 0.659 and 0.742). The sensitivity and specificity of MRI examination for determining histopathological risk factors in our cohort were 64% and 65% for clinically relevant optic infiltration and 87% and 64% for clinically relevant choroidal infiltration. The local tumor extent of retinoblastoma with infiltration of the optic nerve and choroid can be well estimated based on radiological and clinical characteristics before treatment initiation. The combination of clinical and radiological risk factors supports the possibility of early treatment stratification in retinoblastoma patients.

Initial Experience of Clinical Use of [99mTc]Tc-PSMA-T4 in Patients with Prostate Cancer. A Pilot Study.

Numerous different molecules of prostate-specific membrane antigen (PSMA) ligands are used to detect prostate cancer (PCa); most approaches utilize gallium PET and a few reports describe the role of SPECT/CT. [99mTc]Tc-PSMA-T4 is a new radiopharmaceutical designed for the diagnosis of patients with PCa. We conducted a single site, prospective, preliminary case series study that included 31 patients with PCa; all had undergone clinical, biochemical or imaging examination and exhibited clear or suspicious active disease or clinical/biochemical recurrence of PCa. Whole-body (WB) SPECT/CT after i.v. administration of [99mTc]Tc-PSMA-T4 was utilized; acquisition images were obtained at three time points. The clinical value of the images was assessed in regard to the evaluation of tumor extent in patients with confirmed PC that qualified for initial therapy and the evaluation of tumor recurrence; both provided encouraging results. The late acquisition of WB-SPECT resulted in better lesions delineation. The results of the analysis of the sensitivity/specificity were: 92%/100% in cases of primary cancer, 83%/100% in terms of pelvic lymph nodes disease, 100%/95% in other lymph nodes and soft tissue involvement, respectively, and bone mets were both 100%. An oncotropic SPECT [99mTc]Tc-PSMA-T4 can help in selecting a rational therapeutic strategy for a patient with an initial diagnosis of PCa by assessing the extent of cancer and also after complex radical or palliative therapy in case of biochemical recurrence for re-staging.

Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of prostate cancer: a systematic review and meta-analysis

PurposeProstate-specific membrane antigen positron emission tomography (PSMA-PET) has shown promise for detecting nodal and distant prostate cancer (PCa) metastases. However, its performance for local tumor staging is not as well established. The purpose of this study was to review the diagnostic performance of PSMA-PET for determining seminal vesical invasion (SVI) and extraprostatic extension (EPE).MethodsPubmed and Embase databases were searched until January 12, 2020. Studies assessing accuracy of PSMA-PET in determining SVI and EPE were included. Study quality was evaluated with the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity and specificity were calculated using hierarchical summary receiver operating characteristics modeling. Heterogeneity was explored using meta-regression analyses for anatomical imaging component (MRI vs CT) and by testing for a threshold effect.ResultsTwelve studies (615 patients) were included. Pooled sensitivity and specificity were 0.68 (95% CI 0.53-0.81) and 0.94 (95% CI 0.90-0.96) for SVI and 0.72 (95% CI 0.56-0.84) and 0.87 (95% CI 0.72-0.94) for EPE. Meta-regression analyses showed that for SVI, PET/MRI demonstrated greater sensitivity than PET/CT (0.87 [95% CI 0.75-0.98] vs 0.60 [95% CI 0.47-0.74]; p = 0.02 for joint model) while specificity was comparable (0.91 [95% CI 0.84-0.97] vs. 0.96 [95% CI 0.93-0.99]) but not for EPE (p = 0.08). A threshold effect was present for studies assessing EPE (correlation coefficient = 0.563 [95% CI, −0.234-0.908] between sensitivity and false-positive rate).ConclusionPSMA-PET has moderate sensitivity and excellent specificity for assessing local tumor extent in patients with PCa. PET/MRI showed potential for greater sensitivity than PET/CT in assessing SVI.

Tumor-specific Expression of Insulin-like Growth Factor II mRNA-binding Protein 3 Independently Predicts Worse Survival of Patients With Adenocarcinoma of the Ampulla of Vater.

Insulin-like growth factor II mRNA-binding protein 3 (IMP3) plays an important role in the adhesion, invasion, and metastasis of tumor cells. Although emerging evidence suggests that IMP3 promotes tumor progression in several malignancies, the expression of IMP3 and its prognostic implication in adenocarcinoma of the ampulla of Vater (AVAC) has not been clarified to date. The IMP3 expression status in 87 AVAC tissues was examined using immunostaining, and its association with various clinicopathological features and outcome of patients with AVAC was investigated. The vast majority (87.4%) of AVAC cases displayed at least focal cytoplasmic and membranous IMP3 immunoreactivity in tumor cells, whereas IMP3 expression was consistently absent from normal biliary epithelial cells. Tumor-specific IMP3 expression was associated with submucosal and pancreatic invasion, which were not identified in the corresponding hematoxylin and eosin-stained slides. This finding led to up-staging of the pathological tumor stage in two cases of well-differentiated AVAC. In addition, high IMP3 expression was significantly associated with a poorly differentiated histology (p=0.026). Survival analyses revealed that high IMP3 expression independently predicted shorter recurrence-free (p=0.003) and overall (p=0.029) survival. Our study demonstrated tumor-specific IMP3 expression in AVAC, which will be helpful in determining invasion depth and tumor extent in patients with well-differentiated tumors, as well as indicating worse survival of patients with AVAC. Our data highlight IMP3 expression status as a potential diagnostic and prognostic marker for AVAC.

Prognostic Value of Pretreatment Pathological Tumor Extent in Patients Treated With Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal or Junctional Cancer.

We aimed to determine pretreatment pathological tumor extent in the resection specimen after neoadjuvant chemoradiotherapy (nCRT) and to assess its prognostic value in patients with esophageal cancer. Patients with esophageal cancer, treated with nCRT plus surgery were included (2003-2011). Pretreatment pathological T-stage (prepT-stage) and N-stage (prepN-stage) were estimated based on the extent of regressional changes and residual tumor cells in the resection specimen. Interobserver agreement was determined between 3 pathologists. The prognostic performance of prepT-stage and prepN-stage was scored using the difference in Akaike information criterion (ΔAIC). PrepN-stage and posttreatment pathological N-stage (ypN-stage) were combined to determine the effect of nodal sterilization on prognosis. Overall concordance for prepT-stage and prepN-stage was 0.69 and 0.84, respectively. Prognostic strength of prepT-stage was similar to clinical T-stage and worse compared with ypT-stage (ΔAIC 1.3 versus 2.0 and 8.9, respectively). In contrast, prognostic strength of prepN-stage was better than cN-stage and similar to ypN-stage (ΔAIC 17.9 versus 6.2 and 17.2, respectively). PrepN+ patients who become ypN0 after nCRT have a worse survival compared with prepN0 patients, with a five year overall survival of 51% versus 68%, P = 0.019, respectively. PrepT-stage and prepN-stage can be estimated reproducibly. Prognostic strength of prepT-stage is comparable with clinical T-stage, whereas prepN-stage is better than cN-stage. PrepN+ patients who become ypN0 after nCRT have a worse survival compared with prepN0 patients. Pretreatment pathological staging should be considered useful as a new staging parameter for esophageal cancer and could also be of interest for other tumor types.

Usefulness of chromoendoscopy and magnifying narrow band imaging endoscopy for diagnosis of demarcation of adenocarcinoma in Barrett's esophagus

It is often difficult to accurately delineate the borders and extent of early-stage esophageal adenocarcinoma in patients with Barrett's esophagus using conventional white light endoscopy. Chromoendoscopy enhances the characteristics of the mucosa and improves detection and delineation of small or flat lesions difficult to identify by conventional endoscopy. Magnifying endoscopy with narrow-band imaging (NBI) is a novel endoscopic imaging technology that contrasts the vascular architecture and surface structure of the superficial mucosa. As magnifying NBI can view only a narrow area of the mucosa, this method cannot determine the circumference of the lesion and evaluate its complete extent. Indigocarmine chromoendoscopy is useful for delineating the extent of Barrett's adenocarcinoma. Chromoendoscopy and magnifying NBI are complementary methods, with both being required for the accurate diagnosis of tumor extent in patients with superficial Barrett's esophageal adenocarcinoma.

Type-Specific Diagnosis and Evaluation of Longitudinal Tumor Extent of Borrmann Type IV Gastric Cancer: CT versus Gastroscopy

ObjectiveTo compare the accuracy of computed tomography (CT) with that of gastroscopy for the extent of evaluation of longitudinal tumor and type-specific diagnosis of Borrmann type IV gastric cancer.Materials and MethodsFifty-nine patients (35 men with mean age of 60 years and 24 women with mean age of 55 years) who underwent surgical resection of Borrmann type IV gastric cancer were included in this study. Histopathological analysis data was used as a reference standard to confirm the clinical interpretations of gastroscopy and CT for the diagnosis of Borrmann type IV and evaluation of longitudinal tumor extent. For the evaluation of longitudinal extent, gastroscopic and CT results were classified as underestimated, accurate, or overestimated. The McNemar test was used to identify statistically significant differences in the accuracy between gastroscopy and CT.ResultsFor the diagnosis of Borrmann type IV gastric cancer, the accuracy of CT was significantly higher than that of gastroscopy (74.6% [44/59] vs. 44.1% [26/59], p < 0.001). CT was significantly more accurate in assessing the overall tumor extent than gastroscopy (61.4% [35/57] vs. 28.1% [16/57], p < 0.001). The proximal (75.4% [43/57] vs. 50.9% [29/57], p = 0.003) and distal tumor extent (71.9% [41/57] vs. 43.9% [25/57], p < 0.05) were more accurately predicted by CT compared with gastroscopy. The underestimation of tumor extent was a major source of error in both examinations.ConclusionCT was found to be more predictive than gastroscopy in type-specific diagnosis and the evaluation of longitudinal tumor extent in patients with Borrmann type IV gastric cancer.

Evaluation of International Federation of Gynecology and Obstetrics Stage IB Cervical Cancer

The objective of this study was to compare the diagnostic performance of diffusion-weighted (DW) imaging with that of dynamic contrast-enhanced (DCE) imaging in the evaluation of tumor extent in patients with stage IB cervical cancer. This retrospective study was approved by the institutional review board. Between June 2010 and March 2012, 46 consecutive patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB who underwent preoperative DCE, DW (b = 0 and 800 s/mm), and T1- and T2-weighted imaging were included in this study. Two radiologists independently evaluated the extent of cervical cancer and made a diagnosis of tumor stage according to the revised FIGO staging system. The staging accuracy by DCE and DW for readers 1 and 2 was compared with the McNemar test, and κ statistics were used for reader agreement. No statistical difference between the diagnostic performance of staging with DCE and with DW was observed in reader 1 (P = 1.000) or in reader 2 (P = 0.109). Interobserver agreement between the 2 readers for staging was both substantial with DCE (κ = 0.750, P < 0.001) and with DW (κ = 0.683, P < 0.001). The diagnostic performance of DW in distinguishing the subdivision of stage IB cervical cancer was not statistically different from that of DCE. Diffusion-weighted imaging may be preferable to DCE for the preoperative evaluation of stage IB cervical cancer.

Effect of Preoperative Breast Magnetic Resonance Imaging on Surgical Decision Making and Cancer Recurrence Rates

To evaluate breast magnetic resonance imaging (MRI) for cancer staging and surgical planning in patients with known breast cancer, and to evaluate recurrence rates at long-term follow-up. Institutional review board approval and patient consent were obtained. Preoperative MRI with 0.1 mmol/kg gadobenate dimeglumine (MultiHance) was performed in 203/274 women with confirmed breast cancer. The sensitivity, accuracy, and positive predictive value of MRI compared with mammography/ultrasound for malignant lesion detection were calculated, and the effect of MRI on surgical decision making evaluated. The cancer recurrence rate was determined for 172 patients with available 2- to 8-year follow-up data. Mammography/ultrasound detected 229 suspicious lesions. Breast MRI detected 159 additional lesions in 48/203 (23.6%) patients; of which 110/110 were correctly classified as malignant and 28/49 as benign, giving sensitivity, accuracy, and positive predictive values for malignant lesion detection of 100% (110/110), 86.8% (138/159), and 84.0% (110/131), respectively. MRI revealed unsuspected multifocal, multicentric, and synchronous contralateral lesions in 7/48, 16/48, and 16/48 patients, respectively, and pectoralis muscle infiltration in 3/38 patients. In 6/48 women, MRI revealed lesions not seen on conventional imaging (n = 5) or discounted suspected multifocal disease (n = 1). Therapy was changed for 50/203 (24.6%) patients: 38 patients underwent more extensive surgery and 12 less extensive surgery. Six (3.5%) recurrences occurred, in all cases at >4 years. Breast MRI positively affects patient management and is recommended for mapping tumor extent in patients with newly diagnosed cancer. The cancer recurrence rate at long-term follow-up after MRI is low.

Correlation of pain and depression with tumor extent in patients with resected pancreas cancer.

e14616 Background: Psychological tools have been used to assess pain and depression in various cancers and their impact on patient quality of life (Qol). Little is known about such factors in pancreas cancer, especially the correlations of QoL with pathologically-proven disease tumor extent. Methods: We prospectively examined QoL using Fact-Hep and CES-D scores in patients with resected pancreas cancer and correlated scores at presentation with baseline tumor extent. Results: 113 patients were evaluated. There were 63% males and 37% females. Pain was a presenting symptom in 38% in each gender and jaundice was the presenting symptom in 10% of females and 14% of males. Patients with Pain or No Pain at presentation were compared. Patients with pain had more metastases than patients without pain (52% vs. 27%). An ANOVA found higher CEA and depression scores (CES-D) and lower Physical and Functional well-being (FACT-HEP) for patients with pain than those without pain. No differences were found between groups f...

Age and HER2 expression status affect the accuracy of preoperative MRI in predicting tumor extent after neoadjuvant chemotherapy.

Abstract Abstract #5108 Introduction: Neoadjuvant chemotherapy (NAC) can increase the breast conservation rate and provides prognostic information by identifying patients with pathologic complete remission (pCR). While breast conservation can be safely done in patients who show response to NAC, the presence of chemotherapy-induced fibrosis and the heterogeneous patterns of tumor shrinkage may mislead the determination of residual tumor extent during breast conserving surgery. Recent reports show improved preoperative assessment of residual tumor extent after NAC by performing preoperative breast magnetic resonance imagining (MRI) when compared to conventional methods. In this study, we evaluated the accuracy of preoperative breast MRI in predicting residual tumor extent in patients who underwent NAC, and investigated the factors which may influence its accuracy in a relatively large cohort of patients.&amp;#x2028; Materials and Methods: From Jan 2006 to Feb 2008, 195 non-metastatic breast cancer patients received NAC and surgery in Department of Surgery, Seoul National University Hospital. In all patients, preoperative breast MRI was performed in addition to physical examination, mammography, and ultrasonography (USG) to estimate the residual tumor extent. The results were compared to pathologic tumor sizes, and the accuracy of MRI was determined by simple regression analysis. By using the results of immunohistochemical staining, patients were divided into molecular subtypes, and the accuracy of MRI was compared between each subtypes. To identify a subgroup of patients who might benefit from preoperative MRI, the association of MRI accuracy and various clinicopathologic features as well as molecular markers were investigated using linear regression analysis.&amp;#x2028; Results: The mean age of the patients was 45.5 (±9.4) and mean pathologic tumor size was 4.9 (±2.1) cm. pCR was achieved in 31 patients (15.8%). Preoperative MRI and USG showed similar correlation with pathologic invasive tumor size measured from resected specimens (Pearson Coefficient of 0.492 and 0.462, respectively). However, MRI showed superior correlation with tumor extent when the size of surrounding in situ lesions were taken into consideration (Pearson Coefficient of 0.584 for MRI and 0.495 for USG). MRI showed highest correlation with pathologic tumor size in triple negative subtype and lowest correlation in HER2 subtype. Multivariate analysis showed older age (&amp;gt;45 yrs) and HER2 negativity as independent predictors of MRI accuracy. Mammographic density and initial tumor size did not have significant association with MRI accuracy.&amp;#x2028; Conclusion: Preoprative MRI had high correlation with the extent of residual invasive and in situ tumor size after NAC. The accuracy of MRI was highest in patients with triple negative subtype. Multivariate analysis suggested age and CerbB2 expression as independent predictors of MRI accuracy. Although our results need further validation in a prospective setting, this results may provide a basis for selecting patients in whom the benefit of MRI can be maximized. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5108.

Morphological assessment of the interface between tumor and neighboring tissues, by magnetic resonance imaging, before and after radiotherapy in patients with locally advanced rectal cancer

Magnetic resonance imaging (MRI) in rectal cancer is sometimes performed after radiotherapy (MRI 2) to evaluate tumor response and to choose alternative forms of surgery. The accuracy of MRI 2 in distinguishing tumor delineation might be difficult due to fibrosis. To evaluate the morphological changes in the interface between the tumor and neighboring organs on MRI 2 performed after radiotherapy, and to assess the accuracies of MRI before and after radiotherapy compared to histopathology after surgery. Sixteen patients with locally advanced primary rectal cancer, with MRI before and after radiotherapy, were retrospectively studied, concerning the interface between the tumor and neighboring structures. The accuracies of MRI before and after radiotherapy were compared based on histopathology as a reference. The accuracies of both MRI before and after radiotherapy were moderate, with no additional value of MRI after radiotherapy compared to MRI before radiotherapy. The most predictive form of interface for involvement of a neighboring organ after radiotherapy was nodular growth of the tumor into a neighboring structure. The morphological assessment of pelvic MRI after preoperative radiotherapy does not provide any significant new information about tumor extent in patients with locally advanced rectal cancer.

High-Grade Prostatic Intraepithelial Neoplasia in Patients with Prostate Cancer: MR and MR Spectroscopic Imaging Features—Initial Experience

To retrospectively determine the magnetic resonance (MR) and MR spectroscopic imaging features of high-grade prostatic intraepithelial neoplasia (HGPIN) in patients with prostate cancer. Approval of the committee on human research was obtained, with a waiver of consent for this HIPAA-compliant study. Endorectal MR imaging and MR spectroscopic imaging were performed in 48 men (mean age, 59 years; range, 47-75 years) prior to radical prostatectomy for prostate cancer. T2-weighted signal intensity and metabolic ratios of peripheral zone HGPIN foci of 6 mm or greater in diameter were recorded by two readers with knowledge of step-section histopathologic findings using areas of confirmed normal and cancerous peripheral zone tissue for comparison. A random effects statistical model was used to compare metabolic ratios from normal, HGPIN, and cancer voxels. A total of 123 peripheral zone HGPIN foci with a mean diameter of 3 mm (range, 1-28 mm) were identified in 37 (77%) patients, but only 20 foci in 14 patients had a diameter of 6 mm or greater. Six foci were excluded, yielding 14 large HGPIN lesions from 11 patients in the final statistical analysis. The larger HGPIN foci were not associated with any focal reduction in T2-weighted signal intensity but demonstrated metabolic findings intermediate between normal and cancerous tissue; the mean ratios of choline (Cho) to creatine (Cr) for normal, HGPIN, and cancer were 0.92, 1.75, and 1.99, respectively, (P < .01), and the corresponding ratios of Cho plus Cr to citrate were 0.34, 0.50, and 0.78 (P < .01). HGPIN is metabolically intermediate between normal peripheral zone tissue and prostate cancer at MR spectroscopic imaging but does not manifest any MR imaging abnormality and is rarely of sufficient size to cause substantial error in evaluation of peripheral zone tumor extent in patients with prostate cancer.

Thin-Section MRI with a Phased-Array Coil for Preoperative Evaluation of Pelvic Anatomy and Tumor Extent in Patients with Rectal Cancer

The aim of our study was to assess the accuracy of thin-section MRI performed with a phased-array coil as a technique for the preoperative evaluation of pelvic anatomy and tumor extent in patients with rectal cancer. Thin-section MRI with a phased-array coil is accurate and reliable for preoperative evaluation of pelvic anatomy and depth of transmural tumor invasion. Thus, it may be helpful in the selection of the appropriate treatment for patients with rectal cancer.

The value of MRI in the diagnosis and staging of nasopharynx tumors : Casselman JW (Department of Radiology, AZ St.-Jan, Ruddershove 10, B-8000 Brugge, Belgium). J Belg Radiol 1994;77:67–71

The major task of the radiologist is to determine the exact tumor extent in patients with nasopharyngeal tumors. The superior soft tissue contrast resolution and the multiplanar imaging capability make MR the method of choice in the evaluation of nasopharyngeal tumor extension. For the same reasons MR is also the best technique to detect small or occult lesions in patients presenting with positive neck nodes but with a negative clinical nasopharynx examination. Detection of tumor extension along nerves and vessels is earlier and better seen with MR than with any other diagnostic technique. Staging of lymph node metastases is as accurate with MR as with CT, but MR evaluation requires more experience. Finally MR performs better than CT in follow-up of irradiated patients and allows differentiation between tumor recurrence and postradiation fibrosis.

Intraductal ultrasonography for the examination of duodenal papillary region.

The purpose of this study was to provide basic criteria for interpreting images of the normal duodenal papillary region obtained by intraductal ultrasonography at the frequency of 20 MHz. Our in vitro examination of autopsy specimens from 15 patients revealed that the images could be classified into three patterns according to the spatial relationships between the duodenal muscularis propria and the bile duct, or the common duct. Oddi's muscle was clearly demonstrated surrounding the mucosa of the bile duct or the common duct, which was visualized as a hypoechoic layer. The images obtained using in vivo examination of 60 patients with pancreato-biliary disease via either the percutaneous or the peroral approach were similar to the images obtained in vitro. In eight patients with cancer of the papilla of Vater, the tumor was demonstrated clearly on intraductal sonograms. The intraductal imaging features of the normal papillary region were clarified, and the clinical usefulness of this technique in the evaluation of the tumor extent in patients with cancer of the papilla of Vater is suggested.

Automated measurement of tumor extent in patients with colorectal liver metastases from x-ray computed tomography : Perring S, Hunt TM, Fleming JS, et al. (Department of Medical Physics, Southampton General Hospital, Tremona Road, Southampton, Hampshire, S09 4XY, UK) Brit J Radiol 1991;64:494–497

Automated measurement of tumor extent in patients with colorectal liver metastases from x-ray computed tomography : Perring S, Hunt TM, Fleming JS, et al. (Department of Medical Physics, Southampton General Hospital, Tremona Road, Southampton, Hampshire, S09 4XY, UK) Brit J Radiol 1991;64:494–497

Use of the computed tomographic whole body scanner to stage and follow patients with advanced ovarian carcinoma.

Advanced ovarian carcinoma continues to be a difficult tumor to evaluate noninvasively. Recent developments in chemotherapy have enhanced response rates in this disease, thus improving the likelihood of tumor regression. Computed Tomography (CT) allows the noninvasive estimation of tumor extent in patients with ovarian carcinoma. Seventeen patients with epithelial ovarian carcinoma had 22 whole body CT scans performed either just prior to or following laparotomy. For determination of tumor involvement, when the CT was positive, a high pathologic correlation was found at liver, ascitic, peritoneal, mesenteric, and omental sites (sensitivity). When the cT was negative, high pathologic correlation was found at ascitic and mesenteric sites (specificity). Lower and negative correlation at other disease sites is attributed to difficulty of CT detection of small (1 cm) tumor nodules on visceral surfaces. Eighteen patients with advanced ovarian carcinoma were followed prospectively during treatment with repetitive CT scans. CT results were compared with physical examination, other radiologic studies, and clinical status. In 83% (15/18) of patients and 88% (59/67) of CT scans performed, CT was found to contribute useful management information. Clinical decisions were made on the basis of CT alone in 43% (29/67) of scans performed. These data suggest that CT scanning is very useful in the staging and follow-up of patients with ovarian carcinoma and can replace other radiologic procedures, but it is not completely accurate and needs to be correlated with physical examination and in cases without tumors visible with CT, with laparotomy.