Accuracy and clinical relevance of computed tomography scan interpretation of peritoneal cancer index in colorectal cancer peritoneal carcinomatosis: a multi-institutional study.
BACKGROUND
Evaluation of peritoneal metastases by computed tomography (CT) scans is challenging and has been reported to be inaccurate.


METHODS
A multi-institutional prospective observational registry study of patients with peritoneal carcinomatosis from colorectal cancer was conducted and a subset analysis was performed to examine peritoneal cancer index (PCI) based on CT and intraoperative exploration.


RESULTS
Fifty-two patients (mean age 52.6 ± 12.4 years) from 16 institutions were included in this study. Inaccuracies of CT-based assessment of lesion sizes were observed in the RUQ (P = 0.004), LLQ (P < 0.0005), RLQ (P = 0.003), distal jejunum (P = 0.004), and distal ileum (P < 0.0005). When CT-PCI was classified based on the extent of carcinomatosis, 17 cases (33%) were underestimations, of which, 11 cases (21%) were upstaged from low to moderate, 4 cases (8%) were upstaged from low to severe, and 2 cases (4%) were upstaged from moderate to severe. Relevant clinical discordance where an upstage occurred to severe carcinomatosis constituted a true inaccuracy and was observed in six cases (12%).


CONCLUSIONS
The actual clinical impact of inaccuracies of CT-PCI was modest. CT-PCI will remain as a mandatory imaging tool and may be supplemented with other tools including positron emission tomography scan or diagnostic laparoscopy, in the patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Esquivel
J
J
Department of Surgical Oncology, St Agnes Hospital, Baltimore, Maryland 21229, USA. jesusesquivel@yahoo.com
Chua
T C
TC
Stojadinovic
A
A
Melero
J Torres
JT
Levine
E A
EA
Gutman
M
M
Howard
R
R
Piso
P
P
Nissan
A
A
Gomez-Portilla
A
A
Gonzalez-Bayon
L
L
Gonzalez-Moreno
S
S
Shen
P
P
Stewart
J H
JH
Sugarbaker
P H
PH
Barone
R M
RM
Hoefer
R
R
Morris
D L
DL
Sardi
A
A
Sticca
R P
RP
D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D007813:Laparotomy; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D014057:Tomography, X-Ray Computed