CHICAGO - In ovarian cancer patients considered for secondary cytoreductive surgery, preoperative helical CT scanning has been proven a valuable tool in helping doctors predict tumor nonresectability.
In findings presented Tuesday at RSNA 2001, Dr. Stacey Funt explained that preoperative CT predicted tumor nonresectability with 100 percent certainty. To reach this level of predictive value, Funt said physicians should look for two or more of the following CT findings: extranodal pelvic tumors, large bowel obstructions, and iliac vessel involvement or hydronephrosis.
Researchers at the Memorial Sloan-Kettering Cancer Center in New York retrospectively reviewed the presurgical CT findings of 50 patients with a mean age of 57.2 years (ranging from 30 to 79) who underwent secondary cytoreductive surgery for recurrent ovarian cancer. Funt and her colleagues recorded findings of peritoneal carcinomatosis; the location of upper abdominal implants (such as portal triad, perihepatic, lesser sac, gastrosplenic, and mesentery); liver metastasis; large and small bowel obstruction; tumor invasion of the rectosigmoid colon, bladder or iliac vessels; ureteral obstruction; and ascites. The researchers then correlated these findings with surgical pathology and resectability.
At the time of surgery, 22 patients were nonresectable and 28 patients were optimally debulked. CT sensitivity for dominant tumor detection was 100 percent and specificity was 98 percent.
The clear indicators of tumor nonresectability were large bowel obstruction (predictability of 88%), invasion of the rectosigmoid colon (predictability of 65%), involvement of the iliac vessels (predictability of 86%), hydronephrosis (predictability of 83%), carcinomatosis (predictability of 90%), subcapsular liver implants (predictability of 75%), and ascites (predictability of 80%).
The presence of small bowel obstruction, nodal metastasis, or bladder involvement did not correlate with tumor nonresectability, the researchers found.
By Leslie Farnsworth
AuntMinnie.com contributing writer
November 27, 2001
For the rest of our coverage of the 2001 RSNA meeting, go to our RADCast@RSNA 2001.
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