Clinical Utility of Preoperative Assessment in Ovarian Cancer Cytoreduction

Diverse case series of granulomatous peritonitis mimicking advanced ovarian cancer

Background

Epithelial ovarian cancer commonly presents with vague symptoms that delay diagnosis until disease is advanced. Granulomatous peritonitis is a term used to describe granulomatous inflammation within the peritoneal cavity and mimics advanced stage ovarian cancer clinically and on imaging. The goal of this study was to examine the frequency and characteristics of cases of granulomatous peritonitis mimicking ovarian cancer at a single institution and to describe the etiology in this population.

Methods

Eight cases were identified with pathology conformation of granulomatous disease and absence of cancer. The etiologies include pelvic tuberculosis, ruptured dermoid cyst, ruptured hemorrhagic corpus luteum, prior endometriosis surgery, xanthogranulomatous inflammation and three cases of tubo-ovarian abscesses.

Results

Seven of the eight had pelvic masses on imaging studies; one patient had presumed carcinomatosis without an adnexal mass on CT scan. Preoperative CA-125 was elevated in four of the eight patients, with a range of 30.8 to 228 U/mL. All had some form of surgical management with at least one ovary removed.

Conclusion

Clinicians should be aware of this disease to improve diagnosis and direct appropriate patient management.

Neoadjuvant chemotherapy for high-grade serous ovarian cancer: radiologic-pathologic correlation of response assessment and predictors of progression

PURPOSE

Neoadjuvant chemotherapy is often administered for high-grade serous ovarian carcinoma (HGSC) prior to cytoreductive surgery. We evaluated treatment response by CT (simplified peritoneal carcinomatosis index [S-PCI]), pathology (chemotherapy response score [CRS]), laboratory markers (serum CA-125), and surgical outcomes, to identify predictors of disease-free survival.

METHODS

For this retrospective, HIPAA-compliant, IRB-approved study, we identified 396 women with HGSC receiving neoadjuvant chemotherapy between 2010 and 2019. Two hundred and ninety-nine patients were excluded (surgery not performed; imaging/pathology unavailable). Pre- and post-treatment abdominopelvic CTs were assigned CT S-PCI scores 0-24 (higher score indicating more tumor). Specimens were assigned CRS of 1-3 (minimal to complete response). Clinical data were obtained via chart review. Univariate, multivariate, and survival analyses were performed.

RESULTS

Ninety-seven women were studied, with mean age of 65 years ± 10. Interreader agreement was good to excellent for CT S-PCI scores (ICC 0.64-0.77). Despite a significant decrease in CT S-PCI scores after treatment (p < 0.001), mean decrease in CT S-PCI did not differ significantly among CRS categories (p = 0.20) or between patients who were optimally versus suboptimally debulked (p = 0.29). In a survival analysis, lower CRS (more viable tumor) was associated with shorter time to progression (p < 0.001). A joint Cox proportional-hazard models showed that only residual pathologic disease (CRS 1/2) (HR 4.19; p < 0.001) and change in CA-125 (HR 1.79; p = 0.01) predicted progression.

CONCLUSION

HGSC response to neoadjuvant therapy by CT S-PCI did not predict pathologic CRS score, optimal debulking, or progression, revealing discordance between imaging, pathologic, biochemical, and surgical assessments of tumor response.

Affinity-based electrochemical biosensor with antifouling properties for detection of lysophosphatidic acid, a promising early-stage ovarian cancer biomarker

Electrochemical techniques are considered to be highly sensitive, capable of fast response and can be easily miniaturized, properties which can aid with regard to the fabrication of compact point-of-care medical devices; however, the main challenge in developing such a tool is overcoming a ubiquitous, problematic phenomenon known as non-specific adsorption (NSA). NSA is due to the fouling of non-target molecules in the blood on the recognition surface of the device. To overcome NSA, we have developed an affinity-based electrochemical biosensor using medical-grade stainless steel electrodes and following a unique and novel strategy using silane-based interfacial chemistry to detect lysophosphatidic acid (LPA), a highly promising biomarker, which was found to be elevated in 90 % of stage I OC patients and gradually increases as the disease progresses to later stages. The biorecognition surface was developed using the affinity-based gelsolin-actin system, which was previously investigated by our group to detect LPA using fluorescence spectroscopy. We demonstrate the capability of this label-free biosensor to detect LPA in goat serum with a detection limit of 0.7 µM as a proof-of-concept for the early diagnosis of ovarian cancer.