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Tsili AC, Alexiou G, Tzoumpa M, Siempis T, Argyropoulou MI. Imaging of Peritoneal Metastases in Ovarian Cancer Using MDCT, MRI, and FDG PET/CT: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:1467. [PMID: 38672549 PMCID: PMC11048266 DOI: 10.3390/cancers16081467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
This review aims to compare the diagnostic performance of multidetector CT (MDCT), MRI, including diffusion-weighted imaging, and FDG PET/CT in the detection of peritoneal metastases (PMs) in ovarian cancer (OC). A comprehensive search was performed for articles published from 2000 to February 2023. The inclusion criteria were the following: diagnosis/suspicion of PMs in patients with ovarian/fallopian/primary peritoneal cancer; initial staging or suspicion of recurrence; MDCT, MRI and/or FDG PET/CT performed for the detection of PMs; population of at least 10 patients; surgical results, histopathologic analysis, and/or radiologic follow-up, used as reference standard; and per-patient and per-region data and data for calculating sensitivity and specificity reported. In total, 33 studies were assessed, including 487 women with OC and PMs. On a per-patient basis, MRI (p = 0.03) and FDG PET/CT (p < 0.01) had higher sensitivity compared to MDCT. MRI and PET/CT had comparable sensitivities (p = 0.84). On a per-lesion analysis, no differences in sensitivity estimates were noted between MDCT and MRI (p = 0.25), MDCT and FDG PET/CT (p = 0.68), and MRI and FDG PET/CT (p = 0.35). Based on our results, FDG PET/CT and MRI are the preferred imaging modalities for the detection of PMs in OC. However, the value of FDG PET/CT and MRI compared to MDCT needs to be determined. Future research to address the limitations of the existing studies and the need for standardization and to explore the cost-effectiveness of the three imaging modalities is required.
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Affiliation(s)
- Athina C. Tsili
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 45110 Ioannina, Greece; (M.T.); (M.I.A.)
| | - George Alexiou
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - Martha Tzoumpa
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 45110 Ioannina, Greece; (M.T.); (M.I.A.)
| | - Timoleon Siempis
- ENT Department, Ulster Hospital, Upper Newtownards Rd., Dundonald, Belfast BT16 1RH, UK;
| | - Maria I. Argyropoulou
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 45110 Ioannina, Greece; (M.T.); (M.I.A.)
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2
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Wei M, Zhang Y, Ding C, Jia J, Xu H, Dai Y, Feng G, Qin C, Bai G, Chen S, Wang H. Associating Peritoneal Metastasis With T2-Weighted MRI Images in Epithelial Ovarian Cancer Using Deep Learning and Radiomics: A Multicenter Study. J Magn Reson Imaging 2024; 59:122-131. [PMID: 37134000 DOI: 10.1002/jmri.28761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The preoperative diagnosis of peritoneal metastasis (PM) in epithelial ovarian cancer (EOC) is challenging and can impact clinical decision-making. PURPOSE To investigate the performance of T2 -weighted (T2W) MRI-based deep learning (DL) and radiomics methods for PM evaluation in EOC patients. STUDY TYPE Retrospective. POPULATION Four hundred seventy-nine patients from five centers, including one training set (N = 297 [mean, 54.87 years]), one internal validation set (N = 75 [mean, 56.67 years]), and two external validation sets (N = 53 [mean, 55.58 years] and N = 54 [mean, 58.22 years]). FIELD STRENGTH/SEQUENCE 1.5 or 3 T/fat-suppression T2W fast or turbo spin-echo sequence. ASSESSMENT ResNet-50 was used as the architecture of DL. The largest orthogonal slices of the tumor area, radiomics features, and clinical characteristics were used to construct the DL, radiomics, and clinical models, respectively. The three models were combined using decision-level fusion to create an ensemble model. Diagnostic performances of radiologists and radiology residents with and without model assistance were evaluated. STATISTICAL TESTS Receiver operating characteristic analysis was used to assess the performances of models. The McNemar test was used to compare sensitivity and specificity. A two-tailed P < 0.05 was considered significant. RESULTS The ensemble model had the best AUCs, outperforming the DL model (0.844 vs. 0.743, internal validation set; 0.859 vs. 0.737, external validation set I) and clinical model (0.872 vs. 0.730, external validation set II). After model assistance, all readers had significantly improved sensitivity, especially for those with less experience (junior radiologist1, from 0.639 to 0.820; junior radiologist2, from 0.689 to 0.803; resident1, from 0.623 to 0.803; resident2, from 0.541 to 0.738). One resident also had significantly improved specificity (from 0.633 to 0.789). DATA CONCLUSIONS T2W MRI-based DL and radiomics approaches have the potential to preoperatively predict PM in EOC patients and assist in clinical decision-making. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Mingxiang Wei
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yu Zhang
- Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Cong Ding
- Department of Radiology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Jianye Jia
- Department of Radiology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Haimin Xu
- Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Yao Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guannan Feng
- Department of Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Cai Qin
- Department of Radiology, Tumor Hospital Affiliated to Nantong University, Nantong, Jiangsu, China
| | - Genji Bai
- Department of Radiology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Shuangqing Chen
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Hong Wang
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
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3
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Vietti Violi N, Gavane S, Argiriadi P, Law A, Heiba S, Bekhor EY, Babb JS, Ghesani M, Labow DM, Taouli B. FDG-PET/MRI for the preoperative diagnosis and staging of peritoneal carcinomatosis: a prospective multireader pilot study. Abdom Radiol (NY) 2023; 48:3634-3642. [PMID: 36308554 DOI: 10.1007/s00261-022-03703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess the diagnostic performance of FDG-PET/MRI for the preoperative diagnosis and staging of peritoneal carcinomatosis (PC) using surgical Sugarbaker's PC index (PCI) as the reference in a multireader pilot study. METHODS Fourteen adult patients (M/F: 3/11, mean age: 57 ± 12 year) with PC were prospectively included in this single-center study. Patients underwent FDG-PET/MRI prior to surgery (mean delay: 14 d, range: 1-63 d). Images were reviewed independently by 2 abdominal radiologists and 2 nuclear medicine physicians. The radiologists assessed contrast-enhanced abdominal MR images, while the nuclear medicine physicians assessed PET images fused with T2-weighted images. The abdomen was divided in 13 regions, scored from 0 to 3. A hybrid FDG-PET/MRI radiological PCI was created by combining the study data. Radiological PCI was compared to the surgical PCI on a per-patient and per-region basis. Inter-reader agreement was evaluated. RESULTS Mean surgical PCI was 10 ± 8 (range: 0-24). Inter-reader agreement was almost perfect for all sets for radiologic PCI (Kappa: 0.81-0.98). PCI scores for all reading sets significantly correlated with the surgical PCI score (r range: 0.57-0.74, p range: < 0.001-0.003). Pooled per-patient sensitivity, specificity, and accuracy were 75%/50%/71.4% for MRI, 66.7%/50%/64.3% for FDG-PET, and 91.7%/50%/85.7% for FDG-PET/MRI, without significant difference (p value range 0.13-1). FDG-PET/MRI achieved 100% sensitivity and 100% specificity for a cutoff PCI of 20. Per-region sensitivity and accuracy were lower: 37%/61.8% for MRI, 17.8%/64.3% for FDG-PET, and 52.7%/60.4% for FDG-PET/MRI, with significantly higher sensitivity for FDG-PET/MRI. Per-region specificity was higher for FDG-PET (95%) compared to MRI (78.4%) and FDG-PET/MRI (66.5%). CONCLUSION FDG-PET/MRI achieved an excellent diagnostic accuracy per-patient and weaker performance per-region for detection of PC. The added value of PET/MRI compared to MRI and FDG-PET remains to be determined.
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Affiliation(s)
- Naik Vietti Violi
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA
- Department of Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Somali Gavane
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pamela Argiriadi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amy Law
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sherif Heiba
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eliahu Y Bekhor
- Department of Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - James S Babb
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Munir Ghesani
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel M Labow
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA.
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Reginelli A, Giacobbe G, Del Canto MT, Alessandrella M, Balestrucci G, Urraro F, Russo GM, Gallo L, Danti G, Frittoli B, Stoppino L, Schettini D, Iafrate F, Cappabianca S, Laghi A, Grassi R, Brunese L, Barile A, Miele V. Peritoneal Carcinosis: What the Radiologist Needs to Know. Diagnostics (Basel) 2023; 13:diagnostics13111974. [PMID: 37296826 DOI: 10.3390/diagnostics13111974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Peritoneal carcinosis is a condition characterized by the spread of cancer cells to the peritoneum, which is the thin membrane that lines the abdominal cavity. It is a serious condition that can result from many different types of cancer, including ovarian, colon, stomach, pancreatic, and appendix cancer. The diagnosis and quantification of lesions in peritoneal carcinosis are critical in the management of patients with the condition, and imaging plays a central role in this process. Radiologists play a vital role in the multidisciplinary management of patients with peritoneal carcinosis. They need to have a thorough understanding of the pathophysiology of the condition, the underlying neoplasms, and the typical imaging findings. In addition, they need to be aware of the differential diagnoses and the advantages and disadvantages of the various imaging methods available. Imaging plays a central role in the diagnosis and quantification of lesions, and radiologists play a critical role in this process. Ultrasound, computed tomography, magnetic resonance, and PET/CT scans are used to diagnose peritoneal carcinosis. Each imaging procedure has advantages and disadvantages, and particular imaging techniques are recommended based on patient conditions. Our aim is to provide knowledge to radiologists regarding appropriate techniques, imaging findings, differential diagnoses, and treatment options. With the advent of AI in oncology, the future of precision medicine appears promising, and the interconnection between structured reporting and AI is likely to improve diagnostic accuracy and treatment outcomes for patients with peritoneal carcinosis.
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Giuliana Giacobbe
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131 Naples, Italy
| | - Maria Teresa Del Canto
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Marina Alessandrella
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Giovanni Balestrucci
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Gaetano Maria Russo
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Luigi Gallo
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Barbara Frittoli
- Department of Radiology, Spedali Civili Hospital, 25123 Brescia, Italy
| | - Luca Stoppino
- Department of Radiology, University Hospital of Foggia, 71122 Foggia, Italy
| | - Daria Schettini
- Department of Radiology, Villa Scassi Hospital, Corso Scassi 1, 16121 Genova, Italy
| | - Franco Iafrate
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza-University of Rome, Radiology Unit-Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Roberto Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Antonio Barile
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy
| | - Vittorio Miele
- Department of Translational Research, Diagnostic and Interventional Radiology, University of Pisa, 56126 Pisa, Italy
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5
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Alejandra Maestro Durán M, Costas Mora M, Méndez Díaz C, Fernández Blanco C, María Álvarez Seoane R, Soler Fernández R, Rodríguez García E. Role and usefulness of mr imaging in the assessment of peritoneal carcinomatosis. Eur J Radiol 2022; 156:110519. [PMID: 36113382 DOI: 10.1016/j.ejrad.2022.110519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND For many years, peritoneal carcinomatosis (PC) entitled poor prognosis until the development of the cytoreductive surgery technique associated with hyperthermic intraperitoneal chemotherapy. Imaging of peritoneal carcinomatosis plays an essential role in the diagnosis and management of the patients being considered for cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC). MAIN BODY The key role of imaging in patients with peritoneal malignancy is to aid surgical decision making. A standardized peritoneal magnetic resonance (MR) imaging protocol, including T2-weighted fat suppressed, diffusion-weighted and gadolinium-enhanced sequences, allows to detect small peritoneal tumours that are often missed on other imaging. A systematic approach to MR imaging and a close collaboration between the radiologist and the oncologic surgeon are key elements for an accurate evaluation of candidate patients for CRS and HIPEC. CONCLUSION MR imaging provides a powerful tool for accurate preoperative imaging in patients considered for curative surgery and assists the surgeon in evaluating patients for CRS and HIPEC.
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Affiliation(s)
| | - Marta Costas Mora
- Radiology Department. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
| | - Cristina Méndez Díaz
- Radiology Department. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
| | - Celsa Fernández Blanco
- General Sugergy Department. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
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Feng J, Qi C, Lu Y, Wei H, Liang G, Ma R, Bai M. Preoperative plasma D-Dimer level is correlated with peritoneal cancer index of patients with pseudomyxoma peritonei. BMC Surg 2022; 22:372. [PMID: 36316677 PMCID: PMC9624040 DOI: 10.1186/s12893-022-01812-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Accurate assessment of preoperative tumor burden contribute to formulate a scientific surgical plan for patients with pseudomyxoma peritonei (PMP). Present study aimed to assess whether the preoperative plasma D-Dimer level could reflect tumor burden for PMP patients. METHODS A total of 253 PMP patients were included between June 1, 2013 and March 1, 2022. According to the peritoneal cancer index (PCI), all participants were divided into extensive (PCI ≥ 28) and none-extensive (PCI < 28) subgroups. The D-Dimer and tumor markers were compared between the two subgroups. The correlation between the abovementioned biomarkers and PCI will be calculated, and further compared with each other. Two-sided P value less than 0.05 is considered statistically significant. RESULTS The level of D-Dimer (ng/ml) between extensive and none-extensive subgroup were 600 (328, 1268) vs. 339 (128, 598), Z = -5.425, p < 0.001. The Spearman correlation between D-Dimer, carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA 125), CA 19 - 9 and PCI were 0.487, 0.509, 0.469, and 0.499, respectively (all p < 0.001). The correlation coefficients were compared with each other according to Meng, Rosenthal and Rubin's method, however, there was no significant difference. CONCLUSION Preoperative plasma D-Dimer could moderately reflect tumor burden for PMP. In the future, a multivariate prediction model will be developed to help surgeons to formulate a more precise surgical plan for the PMP patients.
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Affiliation(s)
- Jing Feng
- grid.464204.00000 0004 1757 5847Department of Clinical Laboratory, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, 100049 Beijing, China
| | - Changhai Qi
- grid.464204.00000 0004 1757 5847Department of Pathology, Aerospace Center Hospital, 100049 Beijing, China
| | - Yiyan Lu
- grid.464204.00000 0004 1757 5847Department of Pathology, Aerospace Center Hospital, 100049 Beijing, China
| | - Hongjiang Wei
- grid.464204.00000 0004 1757 5847Department of Radiology, Aerospace Center Hospital, 100049 Beijing, China
| | - Guowei Liang
- grid.464204.00000 0004 1757 5847Department of Clinical Laboratory, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, 100049 Beijing, China
| | - Ruiqing Ma
- grid.464204.00000 0004 1757 5847Department of Myxoma, Aerospace Center Hospital, 100049 Beijing, China
| | - Mingjian Bai
- grid.464204.00000 0004 1757 5847Department of Clinical Laboratory, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, 100049 Beijing, China
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7
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Zorzetto G, Coppola A, Molinelli V, Angeretti MG, Casarin J, Fontana F, Piacentino F, Carcano G, Ghezzi F, Venturini M. Spectral CT in peritoneal carcinomatosis from ovarian cancer: a tool for differential diagnosis of small nodules? Eur Radiol Exp 2022; 6:45. [PMID: 36245001 PMCID: PMC9573836 DOI: 10.1186/s41747-022-00302-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/04/2022] [Indexed: 01/17/2023] Open
Abstract
The detection of peritoneal carcinomatosis in patients with ovarian cancer is crucial to establish the correct therapeutic planning (debulking surgery versus neoadjuvant chemotherapy). Often, however, the nodules of peritoneal carcinomatosis are very small in size or have a reticular appearance that can mimic the fat stranding that is typical of acute inflammation conditions. Our hypothesis is that the use of dual-layer spectral computed tomography with its applications, such as virtual monoenergetic imaging and Z-effective imaging, might improve the detection and the characterisation of peritoneal nodules, increasing sensitivity and diagnostic accuracy, as recently described for other oncological diseases.
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8
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Carlson B, Harmath C, Turaga K, Kindler HL, Armato SG, Straus C. The role of imaging in diagnosis and management of malignant peritoneal mesothelioma: a systematic review. Abdom Radiol (NY) 2022; 47:1725-1740. [PMID: 35257201 DOI: 10.1007/s00261-022-03464-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Imaging of the peritoneum and related pathology is a challenge. Among peritoneal diseases, malignant peritoneal mesothelioma (MPeM) is an uncommon tumor with poor prognosis. To date, there are no specific guidelines or imaging protocols dedicated for the peritoneum and MPeM. The objective of this study was to analyze the literature describing imaging modalities used for MPeM to determine their relative clinical efficacy and review commonly reported imaging features of MPeM to promote standardized reporting. METHODS We performed a systematic review of original research articles discussing imaging modalities in MPeM from 1999 to 2020. Effectiveness measures and common findings were compared across imaging modalities. RESULTS Among 582 studies analyzed, the most-used imaging modality was CT (54.3%). In the differentiation of MPeM from peritoneal carcinomatosis, one study found CT had a diagnostic sensitivity of 53%, specificity of 100%, and accuracy of 68%. Two studies found fluorodeoxyglucose positron emission tomography (FDG-PET) had sensitivity of 86-92%, specificity of 83-89%, and accuracy of 87-89%. Another study found magnetic resonance imaging (MRI) was the best predictor of the peritoneal carcinomatosis index. Characteristics shown to best differentiate MPeM from other diseases included ascites, peritoneal thickening, mesenteric thickening, pleural plaques, maximum tumor dimension, and number of masses. CONCLUSION Most published MPeM imaging studies utilized CT. PET/CT or MRI appear promising, and future studies should compare effectiveness of these modalities. MPeM imaging reports should highlight ascites, number of and maximum tumor dimension, peritoneal/mesenteric thickening, and associated pleural plaques, allowing for better aggregation of MPeM imaging data across studies.
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Affiliation(s)
- Bradley Carlson
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
- , Chicago, IL, USA.
| | - Carla Harmath
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Kiran Turaga
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Hedy L Kindler
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Samuel G Armato
- Department of Radiology, University of Chicago, Chicago, IL, USA
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9
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Management of Peritoneal Disease in Colorectal Cancer. Hematol Oncol Clin North Am 2022; 36:569-582. [DOI: 10.1016/j.hoc.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Tortora M, Gemini L, D’Iglio I, Ugga L, Spadarella G, Cuocolo R. Spectral Photon-Counting Computed Tomography: A Review on Technical Principles and Clinical Applications. J Imaging 2022; 8:jimaging8040112. [PMID: 35448239 PMCID: PMC9029331 DOI: 10.3390/jimaging8040112] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 01/01/2023] Open
Abstract
Photon-counting computed tomography (CT) is a technology that has attracted increasing interest in recent years since, thanks to new-generation detectors, it holds the promise to radically change the clinical use of CT imaging. Photon-counting detectors overcome the major limitations of conventional CT detectors by providing very high spatial resolution without electronic noise, providing a higher contrast-to-noise ratio, and optimizing spectral images. Additionally, photon-counting CT can lead to reduced radiation exposure, reconstruction of higher spatial resolution images, reduction of image artifacts, optimization of the use of contrast agents, and create new opportunities for quantitative imaging. The aim of this review is to briefly explain the technical principles of photon-counting CT and, more extensively, the potential clinical applications of this technology.
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Affiliation(s)
- Mario Tortora
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.T.); (L.G.); (I.D.); (L.U.); (G.S.)
| | - Laura Gemini
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.T.); (L.G.); (I.D.); (L.U.); (G.S.)
| | - Imma D’Iglio
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.T.); (L.G.); (I.D.); (L.U.); (G.S.)
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.T.); (L.G.); (I.D.); (L.U.); (G.S.)
| | - Gaia Spadarella
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.T.); (L.G.); (I.D.); (L.U.); (G.S.)
| | - Renato Cuocolo
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende 43, 84081 Baronissi, Italy
- Correspondence:
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11
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Power JW, Dempsey PJ, Yates A, Fenlon H, Mulsow J, Shields C, Cronin CG. Peritoneal malignancy: anatomy, pathophysiology and an update on modern day imaging. Br J Radiol 2022; 95:20210217. [PMID: 34826229 PMCID: PMC9153709 DOI: 10.1259/bjr.20210217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With increasing subspecialised experience in radical cytoreductive surgery and intra-abdominal chemotherapy for peritoneal malignancy, outcomes have improved significantly in selected patients. The surgery and the treatment regimens are radical and therefore correct patient selection is critical. The radiologist plays a central role in this process by estimating, as precisely as possible, the pre-treatment disease burden. Because of the nature of the disease process, accurate staging is not an easy task. Tumour deposits may be very small and in locations where they are very difficult to detect. It must be acknowledged that no form of modern day imaging has the capability of detecting the smallest peritoneal nodules, which may only be visible to direct inspection or histopathological evaluation. Nonetheless, it behoves the radiologist to be as exact and precise as possible in the reporting of this disease process. This is both to select patients who are likely to benefit from radical treatment, and just as importantly, to identify patients who are unlikely to achieve adequate cytoreductive outcomes. In this review, we outline the patterns of spread of disease and the anatomic basis for this, as well as the essential aspects of reporting abdominal studies in this patient group. We provide an evidence-based update on the relative strengths and limitations of our available multimodality imaging techniques namely CT, MRI and positron emission tomography/CT.
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Affiliation(s)
- Jack W Power
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Philip J Dempsey
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Andrew Yates
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Helen Fenlon
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Conor Shields
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Carmel G Cronin
- University College Dublin (UCD) School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
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12
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Delgado-Barriga K, Medina C, Gomez-Quiles L, Marco-Domenech SF, Escrig J, Llueca A. CT Enterography for Preoperative Evaluation of Peritoneal Carcinomatosis Index in Advanced Ovarian Cancer. J Clin Med 2022; 11:jcm11030476. [PMID: 35159927 PMCID: PMC8836697 DOI: 10.3390/jcm11030476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 12/18/2022] Open
Abstract
To compare the diagnostic performance of routine CT (rCT), CT enterography (CTE) and intraoperative quantification of PCI to surgical and pathological reference standards in patients with advanced ovarian cancer, a retrospective study of 122 patients who underwent cytoreduction surgery for ovarian peritoneal carcinomatosis was conducted. Radiological, surgical, and pathological PCIs were obtained from the corresponding reports, and the latter two were considered reference standards. The radiological techniques used were rCT: 64 MDCT (32 × 1 mm) (100 mL iopromide 370 i.v., 800 mL water p.o.), and CTE: 64 MDCT (64 × 0.5 mm) (130 mL iopromide 370 i.v., 1800 mL mannitol solution p.o., 20 mg buscopan i.v.). Data were grouped by imaging technique and analyzed using total PCI and stratified by tumor burden (low-PCI < 10, high-PCI > 20). Agreement, diagnostic performance and degree of cytoreduction were evaluated. Disappointing results for rCT and CTE were obtained when using a surgical referent, but better diagnostic performance and concordance (0.86 vs. 0.78 vs. 0.62, p < 0.05) was observed when using a pathological referent—surgical PCI overestimates and overstaged patients. PCI is underestimated by rCT rather than CTE. For high-PCI, the ROC curve was mediocre for CTE and useless for rCT, as it failed to identify any cases. For low-PCI, the ROC was excellent (86% CTE vs. 75% rCT). In four cases with low-PCI as determined by rCT, cytoreduction was suboptimal. CTE has a better diagnostic performance than rCT in quantifying PCI in patients with advanced ovarian cancer, suggesting that CTE should be used as the initial technique. Surgical-PCI could be considered as an imperfect standard reference.
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Affiliation(s)
- Katty Delgado-Barriga
- Department of Radiology, University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
| | - Carmen Medina
- Department of Pathology, University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
| | - Luis Gomez-Quiles
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
- Department of General Surgery, University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
| | - Santiago F Marco-Domenech
- Department of Radiology, University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
- Department of Medicine, University Jaume I (UJI), 12004 Castelló de la Plana, Spain
| | - Javier Escrig
- Department of Medicine, University Jaume I (UJI), 12004 Castelló de la Plana, Spain
| | - Antoni Llueca
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
- Department of Medicine, University Jaume I (UJI), 12004 Castelló de la Plana, Spain
- Department of Gynecology and Obstetrics, University General Hospital of Castellon, 12004 Castelló de la Plana, Spain
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13
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Imaging of Gastric Carcinomatosis. J Clin Med 2021; 10:jcm10225294. [PMID: 34830575 PMCID: PMC8624519 DOI: 10.3390/jcm10225294] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/06/2021] [Accepted: 11/11/2021] [Indexed: 01/17/2023] Open
Abstract
Diagnosing the absence or presence of peritoneal carcinomatosis in patients with gastric cancer, including its extent and distribution, is an essential step in patients' therapeutic management. Such diagnosis still remains a radiological challenge. In this article, we review the strengths and weaknesses of the different imaging techniques for the diagnosis of peritoneal carcinomatosis of gastric origin as well as the techniques' imaging features. We also discuss the assessment of response to treatment and present recommendations for the follow-up of patients with complete surgical resection according to the presence of risk factors of recurrence, as well as discussing future directions for imaging improvement.
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14
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Bai M, Xu H, Zhang M. ASO Author Reflections: Incomplete Cytoreduction Prediction Model for Pseudomyxoma Peritonei. Ann Surg Oncol 2021; 29:574. [PMID: 34549365 DOI: 10.1245/s10434-021-10817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Mingjian Bai
- Clinical Laboratory Medicine, Peking University Ninth School of Clinical Medicine, Haidian District, 10 Tieyi Road, Beijing, 100038, China.,Clinical Laboratory Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Urinary Cellular Molecular Diagnostics, Beijing, China
| | - Hongbin Xu
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Man Zhang
- Clinical Laboratory Medicine, Peking University Ninth School of Clinical Medicine, Haidian District, 10 Tieyi Road, Beijing, 100038, China. .,Clinical Laboratory Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China. .,Beijing Key Laboratory of Urinary Cellular Molecular Diagnostics, Beijing, China.
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15
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Bai M, Wang S, Liang G, Cai Y, Lu Y, Hou N, Ma R, Xu H, Zhang M. Nomogram to Predict Incomplete Cytoreduction for Pseudomyxoma Peritonei. Ann Surg Oncol 2021; 29:885-892. [PMID: 34480280 DOI: 10.1245/s10434-021-10725-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 08/09/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUNDS The completeness of cytoreduction is one of the most important prognostic factors for patients with pseudomyxoma peritonei (PMP). To date, no nomograms have been established to predict incomplete cytoreduction (IC) for patients with PMP. The current study therefore proposed a nomogram to predict individual IC risk for PMP patients. METHODS Between 1 June 2013, and 22 November 2019, 144 consecutive PMP patients who underwent cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for the first time in our center were included in a retrospective study. Possible predictors of cytoreducibility were analyzed using logistic regression modeling to predict IC for PMP patients. A nomogram was developed based on the multivariate analysis and further investigated for internal validation. RESULTS After CRS, the 144 participants were divided into complete CRS (CCRS) (n = 46) and IC (n = 98) subgroups. Four independent predictors (sex, disease duration, anemia, and carbohydrate antigen 19-9 (CA 199)) were included in the prediction model. Then, a nomogram predicting IC was established based on the aforementioned variables, which demonstrated good predictive accuracy (C-index, 0.837; 95 % confidence interval [CI], 0.764-0.894). The predicted probability was close to the actual observed outcome according to the calibration plot. CONCLUSIONS The current work led to the development of a nomogram capable of predicting IC for PMP patients who demonstrated good performance. Risk stratification by the established nomogram had ability to optimize individual IC prediction and help physicians to establish meticulous preoperative plans.
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Affiliation(s)
- Mingjian Bai
- Clinical Laboratory Medicine, Peking University Ninth School of Clinical Medicine, Beijing, China.,Clinical Laboratory Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Urinary Cellular Molecular Diagnostics, Beijing, China
| | - Shilong Wang
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Guowei Liang
- Department of Clinical Laboratory, Aerospace Center Hospital, Beijing, China
| | - Ying Cai
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Yiyan Lu
- Department of Pathology, Aerospace Center Hospital, Beijing, China
| | - Nianzong Hou
- Department of Hand and Foot Surgery, Zibo Central Hospital, Zibo, Shandong Province, China
| | - Ruiqing Ma
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Hongbin Xu
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Man Zhang
- Clinical Laboratory Medicine, Peking University Ninth School of Clinical Medicine, Beijing, China. .,Clinical Laboratory Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China. .,Beijing Key Laboratory of Urinary Cellular Molecular Diagnostics, Beijing, China.
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16
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Timmerman D, Planchamp F, Bourne T, Landolfo C, du Bois A, Chiva L, Cibula D, Concin N, Fischerova D, Froyman W, Gallardo G, Lemley B, Loft A, Mereu L, Morice P, Querleu D, Testa AC, Vergote I, Vandecaveye V, Scambia G, Fotopoulou C. ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:148-168. [PMID: 33794043 DOI: 10.1002/uog.23635] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the preoperative diagnosis of ovarian tumors, including imaging techniques, biomarkers and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the preoperative diagnosis of ovarian tumors and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the preoperative diagnosis of ovarian tumors and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.
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Affiliation(s)
- D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - F Planchamp
- Clinical Research Unit, Institut Bergonie, Bordeaux, France
| | - T Bourne
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Metabolism, Digestion and Reproduction, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - C Landolfo
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A du Bois
- Department of Gynaecology and Gynaecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - L Chiva
- Department of Gynaecology and Obstetrics, University Clinic of Navarra, Madrid, Spain
| | - D Cibula
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - N Concin
- Department of Gynaecology and Gynaecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - D Fischerova
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - W Froyman
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - G Gallardo
- Department of Radiology, University Clinic of Navarra, Madrid, Spain
| | - B Lemley
- Patient Representative, President of Kraefti Underlivet (KIU), Denmark
- Chair Clinical Trial Project of the European Network of Gynaecological Cancer Advocacy Groups, ENGAGe
| | - A Loft
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - L Mereu
- Department of Gynecology and Obstetrics, Gynecologic Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - P Morice
- Department of Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France
| | - D Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - A C Testa
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Vergote
- Department of Obstetrics and Gynaecology and Gynaecologic Oncology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - V Vandecaveye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Division of Translational MRI, Department of Imaging & Pathology KU Leuven, Leuven, Belgium
| | - G Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Fotopoulou
- Department of Gynecologic Oncology, Hammersmith Hospital, Imperial College, London, UK
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17
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Timmerman D, Planchamp F, Bourne T, Landolfo C, du Bois A, Chiva L, Cibula D, Concin N, Fischerova D, Froyman W, Gallardo G, Lemley B, Loft A, Mereu L, Morice P, Querleu D, Testa C, Vergote I, Vandecaveye V, Scambia G, Fotopoulou C. ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumours. Facts Views Vis Obgyn 2021; 13:107-130. [PMID: 34107646 PMCID: PMC8291986 DOI: 10.52054/fvvo.13.2.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the preoperative diagnosis of ovarian tumours, including imaging techniques, biomarkers and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the preoperative diagnosis of ovarian tumours and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when a consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the preoperative diagnosis of ovarian tumours and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.
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18
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Timmerman D, Planchamp F, Bourne T, Landolfo C, du Bois A, Chiva L, Cibula D, Concin N, Fischerova D, Froyman W, Gallardo Madueño G, Lemley B, Loft A, Mereu L, Morice P, Querleu D, Testa AC, Vergote I, Vandecaveye V, Scambia G, Fotopoulou C. ESGO/ISUOG/IOTA/ESGE Consensus Statement on pre-operative diagnosis of ovarian tumors. Int J Gynecol Cancer 2021; 31:961-982. [PMID: 34112736 PMCID: PMC8273689 DOI: 10.1136/ijgc-2021-002565] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group, and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the pre-operative diagnosis of ovarian tumors, including imaging techniques, biomarkers, and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the pre-operative diagnosis of ovarian tumors and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when a consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the pre-operative diagnosis of ovarian tumors and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.
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Affiliation(s)
- Dirk Timmerman
- Gynecology and Obstetrics, University Hospitals KU Leuven, Leuven, Belgium .,Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Tom Bourne
- Gynecology and Obstetrics, University Hospitals KU Leuven, Leuven, Belgium.,Development and Regeneration, KU Leuven, Leuven, Belgium.,Metabolism Digestion and Reproduction, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - Chiara Landolfo
- Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Andreas du Bois
- Gynaecology and Gynaecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Luis Chiva
- Gynaecology and Obstetrics, University Clinic of Navarra, Madrid, Spain
| | - David Cibula
- Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Nicole Concin
- Gynaecology and Gynaecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany.,Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Fischerova
- Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Wouter Froyman
- Gynecology and Obstetrics, University Hospitals KU Leuven, Leuven, Belgium
| | | | - Birthe Lemley
- European Network of Gynaecological Cancers Advocacy Groups (ENGAGe) Executive Group, Prague, Czech Republic.,KIU - Patient Organisation for Women with Gynaecological Cancer, Copenhagen, Denmark
| | - Annika Loft
- Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Liliana Mereu
- Gynecology and Obstetrics, Gynecologic Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Philippe Morice
- Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France
| | - Denis Querleu
- Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - Antonia Carla Testa
- Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ignace Vergote
- Obstetrics and Gynaecology and Gynaecologic Oncology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Vincent Vandecaveye
- Radiology, University Hospitals Leuven, Leuven, Belgium.,Division of Translational MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Giovanni Scambia
- Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
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19
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Kefleyesus A, Dromain C, Clerc D, Teixeira-Farinha H, Demartines N, Hübner M. Combining imaging and laparoscopy for the staging of peritoneal metastases: A retrospective cohort pilot study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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20
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Seretis C, Gill J, Malik A, Elhassan AM, Shariff U, Youssef H. Low Preoperative Serum Albumin Levels Are Associated With Impaired Outcome After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies. J Clin Med Res 2020; 12:773-779. [PMID: 33447310 PMCID: PMC7781284 DOI: 10.14740/jocmr4362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/09/2020] [Indexed: 12/03/2022] Open
Abstract
Preoperative hypoalbuminemia is known to be associated with postoperative morbidity and mortality, as well as with poor survival after gastrointestinal cancer surgery. However, limited data exist regarding the prognostic significance of hypoalbuminemia in patients with peritoneal metastases undergoing cytoreductive surgery, combined with perioperative intraperitoneal chemotherapy. We performed a systematic literature review of the previously published studies addressing the potential association between preoperative albumin levels and overall surgical outcomes after the performance of cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancies. Our research yielded a total of nine retrospective studies which met our inclusion criteria, and despite their heterogeneity; and we can conclude that preoperatively low albumin levels are associated with greater likelihood of overall and major morbidity, as well as less favorable oncological outcome after the performance of cytoreductive surgery and perioperative intraperitoneal chemotherapy.
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Affiliation(s)
| | - Jagjit Gill
- George Eliot Hospital NHS Trust, Warwickshire, UK
| | - Adnan Malik
- George Eliot Hospital NHS Trust, Warwickshire, UK
| | | | - Umar Shariff
- General Surgery Department, Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Haney Youssef
- General Surgery Department, Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
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21
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Carboni F, Federici O, Giofrè M, Valle M. An 18-Year Experience in Diagnostic Laparoscopy of Peritoneal Carcinomatosis: Results from 744 Patients. J Gastrointest Surg 2020; 24:2096-2103. [PMID: 31432327 DOI: 10.1007/s11605-019-04368-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/12/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite accurate preoperative imaging assessment, optimal cytoreductive surgery with hyperthermic intraperitoneal chemotherapy remains unfeasible in many patients with peritoneal carcinomatosis at the time of surgery. The aim of this study was to evaluate the role of diagnostic laparoscopy in the selection of candidates. METHODS Prospectively collected data of all patients undergoing diagnostic laparoscopy in our Department were retrospectively analyzed. Demographics and perioperative features as well as operative details and outcome were evaluated. RESULTS The study included 744 consecutive patients. Primary ovarian tumors were the most common indications, followed by gastric tumors and recurrent colorectal cancers. The procedure was successfully completed in 99.73% of cases. Approximately two thirds of them (68%) had undergone previous surgical procedures. The presence of ascites was recorded in 482 patients (64.78%). A total of 374 (50.3%) patients were excluded from surgical exploration. Among those who eventually underwent surgery, CC0 resection was obtained in 64.6% (239) of cases. Understaging of peritoneal carcinomatosis was observed in 11 patients (1.48%). Postoperative mortality was null and 5 (0.8%) complications were observed. Three (0.4%) port-site metastases were recorded at the beginning of the experience. CONCLUSION Diagnostic laparosocopy is a safe and feasible tool able to improve the selection of patients eligible for cytoreduction with hyperthermic intraperitoneal chemotherapy, at the same time allowing avoiding a significant number of unnecessary laparotomies.
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Affiliation(s)
- Fabio Carboni
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy.
| | - Orietta Federici
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy
| | - Manuel Giofrè
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy
| | - Mario Valle
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy
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Spectral photon-counting CT imaging of colorectal peritoneal metastases: initial experience in rats. Sci Rep 2020; 10:13394. [PMID: 32770125 PMCID: PMC7414131 DOI: 10.1038/s41598-020-70282-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/23/2020] [Indexed: 12/16/2022] Open
Abstract
Computed tomography imaging plays a major role in the preoperative assessment of tumor burden by providing an accurate mapping of the distribution of peritoneal metastases (PM). Spectral Photon Counting Computed Tomography (SPCCT) is an innovative imaging modality that could overcome the current limitations of conventional CT, offering not only better spatial resolution but also better contrast resolution by allowing the discrimination of multiple contrast agents. Based on this capability, we tested the feasibility of SPCCT in the detection of PM at different time of tumor growth in 16 rats inoculated with CC531 cells using dual-contrast injection protocols in two compartments (i.e. intravenous iodine and intraperitoneal gadolinium or the reverse protocol), compared to surgery. For all peritoneal regions and for both protocols, sensitivity was 69%, specificity was 100% and accuracy was 80%, and the correlation with surgical exploration was strong (p = 0.97; p = 0.0001). No significant difference was found in terms of diagnostic performance, quality of peritoneal opacification or diagnostic quality between the 2 injection protocols. We also showed poor vascularization of peritoneal metastases by measuring low concentrations of contrast agent in the largest lesions using SPCCT, which was confirmed by immunohistochemical analyses. In conclusion, SPCCT using dual-contrast agent injection protocols in 2 compartments is a promising imaging modality to assess the extent of PM in a rat model.
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Stewart JH, Blazer DG, Calderon MJG, Carter TM, Eckhoff A, Al Efishat MA, Fernando DG, Foster JM, Hayes-Jordan A, Johnston FM, Lautz TB, Levine EA, Maduekwe UN, Mangieri CW, Moaven O, Mogal H, Shen P, Votanopoulos KI. The Evolving Management of Peritoneal Surface Malignancies. Curr Probl Surg 2020; 58:100860. [PMID: 33832580 DOI: 10.1016/j.cpsurg.2020.100860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/04/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | - Dan G Blazer
- Division of Surgical Oncology, Duke University Medical Center, Durham, NC
| | | | | | | | | | | | - Jason M Foster
- Fred and Pamela Buffet Cancer Center, University of Nebraska, Omaha, NE
| | | | - Fabian M Johnston
- Complex General Surgical Oncology Program, Johns Hopkins University, Baltimore, MD
| | - Timothy B Lautz
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Ugwuji N Maduekwe
- Division of Surgical Oncology and Endocrine Surgery, University of North Carolina, Chapel Hill, NC
| | | | | | | | - Perry Shen
- Wake Forest University School of Medicine, Winston-Salem, NC
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24
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Jónsdóttir B, Lomnytska M, Poromaa IS, Silins I, Stålberg K. The Peritoneal Cancer Index is a Strong Predictor of Incomplete Cytoreductive Surgery in Ovarian Cancer. Ann Surg Oncol 2020; 28:244-251. [PMID: 32472412 PMCID: PMC7752870 DOI: 10.1245/s10434-020-08649-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Indexed: 12/19/2022]
Abstract
Background Extent of tumor load is an important factor in the selection of ovarian cancer patients for cytoreductive surgery (CRS). The Peritoneal Cancer Index (PCI) gives exact information on tumor load but still is not standard in ovarian cancer surgery. The aim of this study was to find a PCI cutoff for incomplete CRS. The secondary aims were to identify reasons for open-close surgery and to compare surgical complications in relation to tumor burden. Methods The study included 167 women with stage III or IV ovarian cancer scheduled for CRS. Possible predictors of incomplete surgery were evaluated with receiver operator curves, and a PCI cutoff was identified. Surgical complications were analyzed by one-way analysis of variance and Chi square tests. Results The median PCI score for all the patients was 22 (range 3–37) but 33 (range 25–37) for the patients with incomplete surgery (n = 19). The PCI predicted incomplete CRS, with an area under the curve of 0.94 (95% confidence interval [CI], 0.91–0.98). Complete CRS was obtained for 67.2% of the patients with a PCI higher than 24, who experienced an increased rate of complications (p = 0.008). Overall major complications were found in 16.9% of the cases. Only 28.6% of the patients with a PCI higher than 33 achieved complete CRS. The reason for open-close surgery (n = 14) was massive carcinomatosis on the small bowel in all cases. Conclusion The study found PCI to be an excellent predictor of incomplete CRS. Due to a lower surgical success rate, the authors suggest that neoadjuvant chemotherapy could be considered if the PCI is higher than 24. Preoperative radiologic assessment should focus on total tumor burden and not necessarily on specific regions. Electronic supplementary material The online version of this article (10.1245/s10434-020-08649-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Björg Jónsdóttir
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Marta Lomnytska
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Obstetrics and Gynecology, Uppsala University Hospital, Uppsala, Sweden.,Institute of Oncology and Pathology, Karolinska Institutet, Karolinska, Stockholm, Sweden
| | | | - Ilvars Silins
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Karin Stålberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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25
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Lee RM, Zaidi MY, Gamboa AC, Speegle S, Kimbrough CW, Cloyd JM, Leiting JL, Grotz TE, Lee AJ, Fournier KF, Powers BD, Dineen SP, Baumgartner J, Veerapong J, Clarke CN, Sussman JJ, Patel S, Hendrix RJ, Lambert LA, Vande Walle KA, Abbott DE, LaRocca CJ, Raoof M, Fackche N, Johnston FM, Staley CA, Maithel SK, Russell MC. What is the Optimal Preoperative Imaging Modality for Assessing Peritoneal Cancer Index? An Analysis From the United States HIPEC Collaborative. Clin Colorectal Cancer 2019; 19:e1-e7. [PMID: 31974019 DOI: 10.1016/j.clcc.2019.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/30/2019] [Accepted: 12/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Radiographic prediction of peritoneal carcinomatosis index (PCI) can improve patient selection for cytoreductive surgery. We aimed to determine the correlation of computed tomography (CT)-predicted PCI (CT-PCI) and magnetic resonance imaging (MRI)-predicted PCI (MRI-PCI) with intraoperative-PCI, and if a preoperative-PCI cutoff is associated with incomplete cytoreduction. PATIENTS AND METHODS Patients from the US HIPEC Collaborative (2000-2017) with appendiceal, colorectal, or peritoneal mesothelioma (PM) histology who underwent cytoreductive surgery were included. Pearson correlation coefficients were used to determine correlation between preoperative and intraoperative-PCI values. Fisher r-to-z transformation was used to compare correlations. RESULTS A total of 488 patients were included. Of these, 34% had noninvasive appendiceal, 30% invasive appendiceal, 28% colorectal, and 8% PM histology. CT-PCI was correlated with intraoperative-PCI for patients with noninvasive and invasive appendiceal and colorectal histologies (r = 0.689, 0.554, and 0.571; all P < .001), but not PM (r = 0.188; P = .295). MRI-PCI was correlated with intraoperative-PCI for all histologies (non-invasive appendiceal: r = 0.591; P = .002; invasive appendiceal: r = 0.848; P < .001; colorectal: r = 0.729; P < .001; PM: r = 0.890; P = .007). Comparing CT and MRI, correlations were similar in noninvasive appendiceal and colorectal histologies; MRI was better for invasive appendiceal and PM (P = .005 and P = .021, respectively). Twenty-eight (6%) patients underwent an incomplete cytoreduction (cytoreduction score, 2-3). PCI greater than 15 was associated with cytoreduction score of 2 to 3 for both CT and MRI (CT-PCI: odds ratio, 3.0; P = .033; MRI-PCI: odds ratio, 7.6; P = .071). CONCLUSIONS In this multi-institutional cohort, CT and MRI-PCI correlate well with intraoperative-PCI. MRI appears to be superior for invasive appendiceal and peritoneal mesothelioma. External validation in a larger population is needed.
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Affiliation(s)
- Rachel M Lee
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Mohammad Y Zaidi
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Adriana C Gamboa
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Shelby Speegle
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Charles W Kimbrough
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jennifer L Leiting
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN
| | - Travis E Grotz
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN
| | - Andrew J Lee
- Division of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Keith F Fournier
- Division of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Benjamin D Powers
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL
| | - Sean P Dineen
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL
| | - Joel Baumgartner
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, San Diego, CA
| | - Jula Veerapong
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, San Diego, CA
| | - Callisia N Clarke
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | | | - Sameer Patel
- Department of Surgery, University of Cincinnati, Cincinnati, OH
| | - Ryan J Hendrix
- Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA
| | - Laura A Lambert
- Huntsman Cancer Institute, Division of Surgical Oncology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Kara A Vande Walle
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI
| | - Daniel E Abbott
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI
| | - Christopher J LaRocca
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Mustafa Raoof
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Nadege Fackche
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | | | - Charles A Staley
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Maria C Russell
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA.
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Ahmed SA, Abou-Taleb H, Yehia A, El Malek NAA, Siefeldein GS, Badary DM, Jabir MA. The accuracy of multi-detector computed tomography and laparoscopy in the prediction of peritoneal carcinomatosis index score in primary ovarian cancer. Acad Radiol 2019; 26:1650-1658. [PMID: 31101436 DOI: 10.1016/j.acra.2019.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/20/2019] [Accepted: 04/01/2019] [Indexed: 01/09/2023]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to compare the accuracy of MDCT and laparoscopy in the prediction of peritoneal carcinomatosis index score. Reproducibility of MDCT interpretation was also assessed. METHODS This prospective study included 85 ovarian cancer patients underwent MDCT and diagnostic laparoscopy before cytoreductive surgery. We calculated the accuracy of diagnostic modalities in the calculation of the peritoneal cancer index score (PCI). Radiologist interobserver agreement was calculated using kappa statistics. RESULTS Nine hundred-thirty (84.2%) of the 1105 regions had peritoneal deposits at exploratory laparotomy. Computed tomography (CT) and laparoscopy sensitivity were 94.9%, 98.3%, specificity 86.7%, 80.4%, PPV 97.9 %, 96.8%, NPV 72.2%, 88.8 %, and accuracy 93.8 %, 95.7%, respectively. However, computed tomography (CT) diagnostic performance is less accurate than laparoscopy in pelvic and small intestinal regions; no statistically significant differences were evident regarding total PCI score compared to surgery (p> 0.05). CT and laparoscopy correctly depicted peritoneal carcinomatosis in 88.2%, 90.6% of patients, respectively. Optimal cytoreduction was achieved in 68 (80%) patients. CONCLUSION Both CT and laparoscopy seems to be effective tools for assessment of peritoneal carcinomatosis using the PCI score. Dedicated MDCT protocol with routine use of a standardized PCI form may provide better comprehensive multi-regional analysis that may help surgeons referring patients to the best treatment option. Laparoscopy is a valuable tool in cases with a high risk of suboptimal cytoreduction related to disease extent.
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27
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Diffusion-weighted magnetic resonance imaging in peritoneal carcinomatosis from suspected ovarian cancer: Diagnostic performance in correlation with surgical findings. Eur J Radiol 2019; 121:108696. [PMID: 31683251 DOI: 10.1016/j.ejrad.2019.108696] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 09/13/2019] [Accepted: 09/26/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Ovarian cancer (OC) is the commonest cause of death by gynaecological cancer in developed countries. Peritoneal carcinomatosis (PC) complete debulking without residual disease of >1 cm is the best prognostic predictor in advanced OC. PC is assessed with Computed tomography (CT). CT accuracy and cytoreduction success predictive ability are limited. PET/CT is not an imaging standard for PC. PC shows high signal foci in Diffusion-weighted magnetic resonance imaging (DWI MRI). We assessed the diagnostic performance (DP) and tumour burden correlation of Whole body DWI with background suppression MRI (WB-DWIBS/MRI) in PC of suspected OC using the Peritoneal Cancer Index (PCI), referring to cytoreduction surgery as the standard reference. METHOD Fifty patients with suspicion of disseminated OC underwent cytoreduction and WB-DWIBS/MRI. The PCI scores tumour burden (0-3) in 13 anatomical regions (global range of 0-39). Two radiologists (Rad1/Rad2) assessed the PCI preoperatively and with surgical findings. We evaluated regional and global DP, the interobserver agreement (Cohen´s kappa coefficient), statistical differences (McNemar test) and tumour burden (Pearson's test). RESULTS 72% (36/50) were epithelial OC and 78% (39/50) achieved complete cytoreduction. Global-PCI correlation was 0.762 (Rad1) with DP: Sensitivity 0.84, specificity 0.89, accuracy 0.89, and kappa 0.41. Average global-PCI was 7. The pelvis and right hypochondrium showed the highest positive rate and DP, while the intestinal regions presented the lowest. Previous studies reported higher sensitivity than CT or PET/CT, although only a few used the PCI. CONCLUSIONS WB-DWIBS/MRI is reliable to depict, quantify and to predict complete cytoreductive surgery in OC PC.
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28
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Bonnet E, Mastier C, Lardy-Cléaud A, Rochefort P, Sarabi M, Guibert P, Cattey-Javouhey A, Desseigne F, de La Fouchardière C. FOLFIRINOX in patients with peritoneal carcinomatosis from pancreatic adenocarcinoma: a retrospective study. ACTA ACUST UNITED AC 2019; 26:e466-e472. [PMID: 31548814 DOI: 10.3747/co.26.4903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Peritoneal carcinomatosis (pcm) in metastatic pancreatic ductal adenocarcinomas (mpdac) is frequently encountered in day-to-day practice, but rarely addressed in the literature. The objective of the present study was to describe the management and outcome of patients diagnosed with pcm. Methods Data for all consecutive patients with mpdac treated in our centre between 1 January 2014 and 31 August 2015 were analyzed retrospectively. Computed tomography imaging was centrally reviewed by a dedicated radiologist to determine the date of pcm diagnosis. Results The analysis included 48 patients. Median age in the group was 61 years, and 41 patients had an Eastern Cooperative Oncology Group performance status (ecog ps) of 0-1. All patients presented with pcm either synchronously (group 1) or metachronously (group 2). Those groups differed significantly by baseline ecog ps and neutrophil-to-lymphocyte ratio (nlr), with ecog ps being poorer and nlr being higher in group 1. In addition to pcm, the main sites of metastasis were liver (62.5%) and lungs (31.3%). First-line chemotherapy in 36 patients (75%) was folfirinox (fluorouracil-irinotecan-leucovorin-oxaliplatin). The median overall survival for the entire population was 10.81 months [95% confidence interval (ci): 7.16 months to 14.16 months]; it was 13.17 months (95% ci: 5.9 months to 15.4 months) for patients treated with folfirinox. Median overall survival was 7.13 months (95% ci: 4.24 months to 10.41 months) for patients in group 1 and 14.34 months (95% ci: 9.79 months to 19.91 months) for patients in group 2, p = 0.1296. Conclusions Compared with other metastatic sites, synchronous pcm seems to be a poor prognostic factor. It could be more frequently associated with a poor ecog ps and a nlr greater than 5 in this group of patients. In patients with mpdac and pcm, either synchronous or metachronous, folfirinox remains an efficient regimen.
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Affiliation(s)
- E Bonnet
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - C Mastier
- Radiology Department, Centre Léon Bérard, Lyon, France
| | - A Lardy-Cléaud
- Clinical Research and Innovation Department, Centre Léon Bérard, Lyon, France
| | - P Rochefort
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - M Sarabi
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - P Guibert
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | | | - F Desseigne
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
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29
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Sánchez-Hidalgo JM, Rodríguez-Ortiz L, Arjona-Sánchez Á, Rufián-Peña S, Casado-Adam Á, Cosano-Álvarez A, Briceño-Delgado J. Colorectal peritoneal metastases: Optimal management review. World J Gastroenterol 2019; 25:3484-3502. [PMID: 31367152 PMCID: PMC6658395 DOI: 10.3748/wjg.v25.i27.3484] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/20/2019] [Accepted: 06/23/2019] [Indexed: 02/06/2023] Open
Abstract
The peritoneum is a common site of dissemination for colorrectal cancer, with a poorer prognosis than other sites of metastases. In the last two decades, it has been considered as a locoregional disease progression and treated as such with curative intention treatments. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the actual reference treatment for these patients as better survival results have been reached as compared to systemic chemotherapy alone, but its therapeutic efficacy is still under debate. Actual guidelines recommend that the management of colorectal cancer with peritoneal metastases should be led by a multidisciplinary team carried out in experienced centers and consider CRS + HIPEC for selected patients. Accumulative evidence in the last three years suggests that this is a curative treatment that may improve patients disease-free survival, decrease the risk of recurrence, and does not increase the risk of treatment-related mortality. In this review we aim to gather the latest results from referral centers and opinions from experts about the effectiveness and feasibility of CRS + HIPEC for treating peritoneal disease from colorectal malignancies.
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Affiliation(s)
| | - Lidia Rodríguez-Ortiz
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Álvaro Arjona-Sánchez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Sebastián Rufián-Peña
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Ángela Casado-Adam
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Antonio Cosano-Álvarez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Javier Briceño-Delgado
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
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30
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Extended abdominopelvic MRI versus CT at the time of adnexal mass characterization for assessing radiologic peritoneal cancer index (PCI) prior to cytoreductive surgery. Abdom Radiol (NY) 2019; 44:2254-2261. [PMID: 30788559 DOI: 10.1007/s00261-019-01939-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate whether extending the MRI scan to include the abdomen at the time of adnexal mass characterization could replace additional CT for peritoneal cancer index (PCI) assessment. METHODS After institutional review board approval for this prospective study, 36 consecutive females with ovarian and FT malignancies were included. All patients signed an informed consent. Patients underwent preoperative CT (32 patients) and MRI (36 patients). Images were interpreted by 2 independent observers. Surgical data were available in 27 patients. Region-by-region analysis was performed for detection rates of peritoneal carcinomatosis (PC). Inter-observer agreement for each region was evaluated by kappa statistics. Radiologic PCI was calculated by CT and MRI independently and inter-observer agreement for CT and MRI as well as agreement between radiologic and surgical PCI were evaluated by weighted-kappa statistics. RESULTS On region-by-region analysis, the highest detection rates of PC were noted at the central abdomen and pelvis. Detection rates were higher by MRI than CT, mainly in bowel serosal surface, pelvis, and right upper abdomen regions. Inter-observer agreement of MRI was higher than CT in most regions. The median PCI by CT was 5 and 4 for the first and second observers (range 0-21 for both observers), respectively. The median PCI by MRI was 6 (range 0-23 for both observers). The inter-observer agreement of PCI was excellent by both CT and MRI (k = 0.876 and k = 0.912, respectively). The agreement between CT and surgical PCI was 0.660 and 0.590 for the first and second observers, respectively. The agreement between MRI and surgical PCI was 0.797 and 0.798 for the first and second observers, respectively. CONCLUSIONS Extending MRI scan to include the abdomen at the time of adnexal mass characterization allows accurate estimation of PC, with better results than CT, obviating the need for dedicated CT scan of abdomen and pelvis for imaging of PC.
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Low RN, Barone RM, Rousset P. Peritoneal MRI in patients undergoing cytoreductive surgery and HIPEC: History, clinical applications, and implementation. Eur J Surg Oncol 2019; 47:65-74. [PMID: 30852063 DOI: 10.1016/j.ejso.2019.02.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/15/2019] [Accepted: 02/22/2019] [Indexed: 11/26/2022] Open
Abstract
MR imaging provides considerable advantages in the evaluation of patients with peritoneal metastases. A standardized peritoneal MRI protocol, including diffusion-weighted and gadolinium-enhanced sequences, allows an efficient exploration of small peritoneal tumors that are often missed on other imaging tests. In experienced hands, a dedicated reading allows producing a quantitative and qualitative evaluation of lesional localization to better assist surgeons in the selection of candidates for curative surgery by evaluating the possibility of complete resection, and to plan the surgical procedure. Based on a close collaboration between oncologic surgeon and radiologist, MRI provides a powerful tool for accurate preoperative imaging in patients being considered for curative surgery but also in their surveillance to detect an early recurrence.
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Affiliation(s)
- Russell N Low
- Department of Radiology, Sharp Memorial Hospital, 7901 Frost Street, San Diego, CA, 92123, USA.
| | - Robert M Barone
- Department of Surgical Oncology, Sharp Memorial Hospital, 7901 Frost Street, San Diego, CA, 92123, USA.
| | - Pascal Rousset
- Department of Radiology, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France; Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France.
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Preoperative assessment of splenic involvement in patients with peritoneal carcinomatosis with CT and MR imaging. Eur J Radiol 2019; 110:60-65. [DOI: 10.1016/j.ejrad.2018.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 01/01/2023]
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Moghazy Mohamed D, Abd El-Wahab abo Dewan K, Mahmoud Mera S. The Diagnostic accuracy of transvaginal ultrasonography, magnetic resonance imaging and diffusion weighted image in female patients with endometrial carcinoma. ALEXANDRIA JOURNAL OF MEDICINE 2018. [DOI: 10.1016/j.ajme.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
MRI provides considerable advantages for imaging of patients with peritoneal tumor. Its inherently superior contrast resolution compared with computed tomography allows MRI to more accurately depict small peritoneal tumors that are often missed on other imaging tests. Combining different contrast mechanisms, including diffusion-weighted MRI and gadolinium-enhanced MRI, provides a powerful tool for preoperative and surveillance imaging in patients being considered for cytoreductive surgery and heated intraperitoneal chemotherapy.
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Affiliation(s)
- Russell N Low
- Department of Radiology, Sharp Memorial Hospital, 7901 Frost Street, San Diego, CA 92123, USA.
| | - Robert M Barone
- Department of Surgical Oncology, Sharp Memorial Hospital, 7901 Frost Street, San Diego, CA 92123, USA
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35
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Preoperative CT-based predictive factors for resectability and medium-term overall survival in patients with peritoneal carcinomatosis from colorectal cancer. Clin Radiol 2018; 73:756.e11-756.e16. [DOI: 10.1016/j.crad.2018.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/22/2018] [Indexed: 12/12/2022]
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Chandramohan A, Thrower A, Smith SA, Shah N, Moran B. "PAUSE": a method for communicating radiological extent of peritoneal malignancy. Clin Radiol 2017; 72:972-980. [PMID: 28778454 DOI: 10.1016/j.crad.2017.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/16/2017] [Accepted: 07/03/2017] [Indexed: 11/24/2022]
Abstract
Radiology reports of diffuse peritoneal disease should address key findings pertinent to the management of these patients. The reporting of radiology findings in patients with peritoneal malignancy is currently variable and poorly standardised. Using the acronym "PAUSE" we emphasise the key imaging features that a radiology report should include in a patient with peritoneal malignancy, focussing on the key elements determining feasibility and likely prognosis of surgery and potential benefits from cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The term "PAUSE" incorporates the following: P, primary tumour and peritoneal carcinomatosis index (PCI) as estimated by imaging; A, ascites and abdominal wall involvement; U, unfavourable sites of involvement; S, small bowel and mesenteric disease; E, extra peritoneal metastases. Thus, "PAUSE" has the potential to standardise radiology reporting in this field.
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Affiliation(s)
- A Chandramohan
- Department of Radiology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, RG24 9NA, UK; Department of Radiology, Christian Medical College, Vellore, India.
| | - A Thrower
- Department of Radiology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, RG24 9NA, UK
| | - S A Smith
- Department of Radiology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, RG24 9NA, UK
| | - N Shah
- Department of Radiology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, RG24 9NA, UK
| | - B Moran
- Department of Surgery, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, RG24 9NA, UK
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Tan GHC, Shamji T, Mehta A, Chandrakumaran K, Dayal S, Mohamed F, Carr NJ, Rowaiye B, Cecil T, Moran BJ. Diagnostic and therapeutic laparoscopy in assessment and management of patients with appendiceal neoplasms. Int J Hyperthermia 2017; 34:336-340. [DOI: 10.1080/02656736.2017.1338363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Grace Hwei Ching Tan
- Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Tushar Shamji
- Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Akash Mehta
- Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Kandiah Chandrakumaran
- Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Sanjeev Dayal
- Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Faheez Mohamed
- Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Norman J. Carr
- Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Babtunde Rowaiye
- Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Tom Cecil
- Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Brendan J. Moran
- Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
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1st Evidence-based Italian consensus conference on cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinosis from ovarian cancer. TUMORI JOURNAL 2017; 103:525-536. [PMID: 28430350 DOI: 10.5301/tj.5000623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 12/11/2022]
Abstract
Ovarian cancer (OC) remains relatively rare, although it is among the top 4 causes of cancer death for women younger than 50. The aggressive nature of the disease and its often late diagnosis with peritoneal involvement have an impact on prognosis. The current scientific literature presents ambiguous or uncertain indications for management of peritoneal carcinosis (PC) from OC, both owing to the lack of sufficient scientific data and their heterogeneity or lack of consistency. Therefore, the Italian Society of Surgical Oncology (SICO), the Italian Society of Obstetrics and Gynaecology, the Italian Association of Hospital Obstetricians and Gynaecologists, and the Italian Association of Medical Oncology conducted a multidisciplinary consensus conference (CC) on management of advanced OC presenting with PC during the SICO annual meeting in Naples, Italy, on September 10-11, 2015. An expert committee developed questions on diagnosis and staging work-up, indications, and procedural aspects for peritonectomy, systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy for PC from OC. These questions were provided to 6 invited speakers who answered with an evidence-based report. Each report was submitted to a jury panel, representative of Italian experts in the fields of surgical oncology, gynecology, and medical oncology. The jury panel revised the reports before and after the open discussion during the CC. This article is the final document containing the clinical evidence reports and statements, revised and approved by all the authors before submission.
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Dohan A, Hoeffel C, Soyer P, Jannot AS, Valette PJ, Thivolet A, Passot G, Glehen O, Rousset P. Evaluation of the peritoneal carcinomatosis index with CT and MRI. Br J Surg 2017; 104:1244-1249. [PMID: 28376270 DOI: 10.1002/bjs.10527] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/03/2017] [Accepted: 02/07/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim was to determine the incremental value of MRI compared with CT in the preoperative estimation of the peritoneal carcinomatosis index (PCI). METHODS CT and MRI examinations of patients with peritoneal carcinomatosis were evaluated. CT images were first analysed by two observers who determined a first PCI (PCICT ). Then, the two observers reviewed MRI examinations in combination with CT and determined a second PCI (PCICT+MRI ). The sensitivity and negative predictive value of the two imaging sets were determined using surgery as a reference standard (PCIRef ). RESULTS CT plus MRI was more accurate in predicting the surgical PCI than CT alone. The absolute difference between PCICT+MRI and PCIRef was lower than that between PCICT and PCIRef (mean(s.d.) 3·96(4·10) versus 4·89(4·73); P = 0·010). The number of true-positive findings increased from 106 to 125 for reader 1 and from 117 to 132 for reader 2 with the adjunct of MRI. For both readers, an increased sensitivity was obtained when both MRI and CT were used (from 63 to 81 per cent for reader 1; from 44 to 81 per cent for reader 2). The increase in sensitivity was greater for patients with a moderate volume of disease. CONCLUSION The combination of CT and MRI improved the preoperative estimation of PCI compared with CT alone.
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Affiliation(s)
- A Dohan
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Diderot-Paris 7 and Institut National de la Santé et de la Recherche Médicale (INSERM) U965, AP-HP, Paris, France.,Department of Radiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - C Hoeffel
- Department of Radiology, Hôpital Robert-Debré, Reims, France
| | - P Soyer
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Diderot-Paris 7 and Institut National de la Santé et de la Recherche Médicale (INSERM) U965, AP-HP, Paris, France
| | - A S Jannot
- INSERM-Unité Mixte de Recherche en Santé 1138 Team 22, Cordeliers Research Centre, Paris Descartes University, Department of Medical Informatics and Public Health, European George Pompidou Hospital, AP-HP, Paris, France
| | - P-J Valette
- Department of Radiology, Centre Hospitalier Lyon Sud - Hospices Civils de Lyon, Lyon 1 University, Equipe Mixte de Recherche 3738, Lyon, France
| | - A Thivolet
- Department of Radiology, Centre Hospitalier Lyon Sud - Hospices Civils de Lyon, Lyon 1 University, Equipe Mixte de Recherche 3738, Lyon, France
| | - G Passot
- Department of Digestive and Oncological Surgery, Centre Hospitalier Lyon Sud - Hospices Civils de Lyon, Lyon 1 University, Equipe Mixte de Recherche 3738, Lyon, France
| | - O Glehen
- Department of Digestive and Oncological Surgery, Centre Hospitalier Lyon Sud - Hospices Civils de Lyon, Lyon 1 University, Equipe Mixte de Recherche 3738, Lyon, France
| | - P Rousset
- Department of Radiology, Centre Hospitalier Lyon Sud - Hospices Civils de Lyon, Lyon 1 University, Equipe Mixte de Recherche 3738, Lyon, France
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Abstract
OBJECTIVE The purpose of this article is to discuss the role of the radiologist in the treatment of peritoneal cancer, with focus placed on advanced treatment options and selection of patients with resectable disease for whom complete cytoreduction can be achieved. CONCLUSION Peritoneal cancers traditionally have been associated with significant morbidity and universal mortality; however, the management of such cancers has evolved substantially. Advanced treatment options, including cytoreductive surgery and intraperitoneal chemotherapy, are associated with significantly improved long-term patient survival. To ensure that patients benefit from aggressive multimodality treatments, the radiologist plays a pivotal role in the multidisciplinary team to ensure careful patient selection, identifying individuals with resectable disease for whom complete cytoreduction can be achieved.
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Krishnamurthy S, Balasubramaniam R. Role of Imaging in Peritoneal Surface Malignancies. Indian J Surg Oncol 2016; 7:441-452. [PMID: 27872533 PMCID: PMC5097766 DOI: 10.1007/s13193-016-0539-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/02/2016] [Indexed: 12/13/2022] Open
Abstract
Imaging plays a vital role in the evaluation of peritoneal malignancies. The presence of peritoneal metastases (PM) alters tumor staging, with direct implications in treatment choice and prognosis. Cytoreductive surgery (CRS) and Hyperthermic intraperitoneal chemotherapy (HIPEC) as a combined modality treatment have led to prolonged survival and even cure in selected patients with PM. Better outcomes are seen in patients with limited disease spread. Therefore, early diagnosis of peritoneal tumor seeding is essential. Despite significant advancement of technology, assessment of the origin of PM is often difficult, due partly to the complex peritoneal anatomy and partly due to the complex overlap of imaging features. Multidetector CT (MDCT) is the main stay due to its wide availbility, rapid evaluation, robust technique and good resolution. Imaging plays a vital role in selecting patients for the combined modality treatment. MRI is not as popular as CT due to limited availability, time required for the study and lack of experience with interpreting the results. PET-CT is useful in ruling out extra peritoneal disease and it is the CT component that is more reliable for predicting the disease extent. This article reviews the current use of various imaging modalities in various stages of treatment of patients with PM especially those undergoing CRS and HIPEC.
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Menassel B, Duclos A, Passot G, Dohan A, Payet C, Isaac S, Valette P, Glehen O, Rousset P. Preoperative CT and MRI prediction of non-resectability in patients treated for pseudomyxoma peritonei from mucinous appendiceal neoplasms. Eur J Surg Oncol 2016; 42:558-66. [DOI: 10.1016/j.ejso.2016.01.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/18/2015] [Accepted: 01/07/2016] [Indexed: 11/16/2022] Open
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Low RN. Preoperative and surveillance MR imaging of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy. J Gastrointest Oncol 2016; 7:58-71. [PMID: 26941984 DOI: 10.3978/j.issn.2078-6891.2015.115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
MR imaging provides considerable advantages for imaging patients with peritoneal tumor. Its inherently superior contrast resolution compared to CT allows MRI to more accurately depict small peritoneal tumors that are often missed on other imaging tests. Combining different contrast mechanisms including diffusion-weighted (DW) MRI and gadolinium-enhanced MRI provides a powerful tool for preoperative and surveillance imaging in patients being considered for cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC).
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Affiliation(s)
- Russell N Low
- Department of Radiology and Sharp and Children's MRI Center, Sharp Memorial Hospital, San Diego, CA 92123, USA
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Mehta SS, Bhatt A, Glehen O. Cytoreductive Surgery and Peritonectomy Procedures. Indian J Surg Oncol 2016; 7:139-51. [PMID: 27065704 DOI: 10.1007/s13193-016-0505-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/28/2016] [Indexed: 12/13/2022] Open
Abstract
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become widely accepted as an effective method of treating peritoneal metastases (PM) from various cancers. CRS performed with the goal of removing all the macroscopic disease and comprises of peritonectomy procedures and visceral resections. CRS is a technically challenging surgery that requires a considerable amount of skill and appropriate patient selection. This article is a review of the techniques and current recommendations for performing CRS.
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Affiliation(s)
- Sanket S Mehta
- Division of Peritoneal Surface Oncology, Saifee Hospital, MK marg, Charni road, Girgaon, Mumbai, 400004 India
| | - Aditi Bhatt
- Fortis Hospitals Limited, 154/9, Bannerghatta Road, Opp. IIM-B, Bangalore, 560076 India
| | - Olivier Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre Bénite, France ; Université Lyon 1, EMR 3738, 69600 Oullins, France
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Baratti D, Kusamura S, Pietrantonio F, Guaglio M, Niger M, Deraco M. Progress in treatments for colorectal cancer peritoneal metastases during the years 2010-2015. A systematic review. Crit Rev Oncol Hematol 2016; 100:209-22. [PMID: 26867984 DOI: 10.1016/j.critrevonc.2016.01.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/25/2015] [Accepted: 01/16/2016] [Indexed: 02/08/2023] Open
Abstract
Peritoneal metastases (PM) from colorectal cancer (CRC) were traditionally associated with bad prognosis. Only recently, cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has resulted in survival improvements. A systematic literature search between January 2010 and June 2015 was performed. Studies were selected and appraised according to predetermined criteria. Nineteen cohort studies, and thirteen comparative studies of CRS/HIPEC were included. The weighted median overall survival was 31.6 months (range 16-51). Major morbidity was 17.6-52.4% (weighted average 32.6%). Mortality was 0-8.1% (weighted average 2.9%). Additional relevant topics, such as CRC-PM prevalence, results by systemic therapies, preoperative work-up, and technical aspects were summarized through a narrative review. The recent literature suggests that CRS/HIPEC is gaining acceptance as standard of care for selected CRC-PM patients. Refinement of selection criteria, and rationalization of comprehensive systemic and local-regional management is ongoing. Prevention and early treatment of PM are new and promising options.
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Affiliation(s)
- Dario Baratti
- Peritoneal Malignancy Program, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian, 1 20133 Milano, Italy
| | - Shigeki Kusamura
- Peritoneal Malignancy Program, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian, 1 20133 Milano, Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian, 1 20133 Milano, Italy
| | - Marcello Guaglio
- Peritoneal Malignancy Program, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian, 1 20133 Milano, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian, 1 20133 Milano, Italy
| | - Marcello Deraco
- Peritoneal Malignancy Program, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian, 1 20133 Milano, Italy.
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Mohkam K, Passot G, Cotte E, Bakrin N, Gilly FN, Ledochowski S, Bernard L, Valette PJ, Glehen O, Rousset P. Resectability of Peritoneal Carcinomatosis: Learnings from a Prospective Cohort of 533 Consecutive Patients Selected for Cytoreductive Surgery. Ann Surg Oncol 2015; 23:1261-70. [DOI: 10.1245/s10434-015-5005-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Indexed: 12/27/2022]
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Sammartino P, Biacchi D, Cornali T, Accarpio F, Sibio S, Luraschi B, Impagnatiello A, Di Giorgio A. Computerized System for Staging Peritoneal Surface Malignancies. Ann Surg Oncol 2015; 23:1454-60. [PMID: 26564242 PMCID: PMC4819745 DOI: 10.1245/s10434-015-4966-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Indexed: 11/22/2022]
Abstract
Background Peritoneal surface malignancies (PSMs) are usually staged using Sugarbaker’s Peritoneal Cancer Index (PCI) and completeness of cytoreduction score (CC-s). Although these staging tools are essential for selecting patients and evaluating outcome after cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC), both scoring models lack some anatomic information, thus making staging laborious and unreliable. Maintaining Sugarbaker’s original concepts, we therefore developed a computerized digital tool, including a new anatomic scheme for calculating PCI and CC-s corresponding closely to patients’ real anatomy. Our new anatomic model belongs in a web-based application known as the PSM Staging System, which contains essential clinical and pathological data for the various PSMs currently treated. Methods The new digital tool for staging PSM runs on a personal computer or tablet and comprises male and female colored anatomic models for the 13 endoabdominal regions, with borders defined according to real anatomic landmarks. A drag-and-drop tool allows users to compute the PCI and CC-s, making it easier to localize and quantify disease at diagnosis and throughout treatment, and residual disease after CRS. Conclusions Once tested online by registered users, our computerized application should provide a modern, shareable, comprehensive, user-friendly PSM staging system. Its anatomic features, along with the drag-and-drop tool, promise to make it easier to compare preoperative and postoperative PCIs, thus improving the criteria for selecting patients to undergo CRS plus HIPEC. By specifying the size, site, and number of residual lesions after CRS plus HIPEC, our digital tool should help stratify patients into outcome classes. Electronic supplementary material The online version of this article (doi:10.1245/s10434-015-4966-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paolo Sammartino
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy.
| | - Daniele Biacchi
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | - Tommaso Cornali
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | - Fabio Accarpio
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | - Simone Sibio
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | - Bernard Luraschi
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | | | - Angelo Di Giorgio
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
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