title: Ultrasound evaluation of intra-abdominal sites of disease to predict likelihood of suboptimal cytoreduction in advanced ovarian cancer: a prospective study.
abstract: OBJECTIVE
  To analyze in advanced ovarian cancer patients the ability of ultrasound to evaluate the extent of intra-abdominal disease and to predict the likelihood of suboptimal cytoreduction.
  
  
  METHODS
  Into this prospective study, 147 patients with advanced ovarian cancer were enrolled consecutively between January 2005 and October 2008. All patients underwent standard laparotomy and maximal surgical effort was attempted. To create a new scoring system to predict suboptimal cytoreduction we considered the following sonographic parameters: peritoneal carcinomatosis, bowel mesentery involvement, omental involvement, massive pelvic involvement, ascites and liver and/or spleen metastases. Those parameters achieving a negative predictive value ≥ 50% and a positive predictive value ≥ 50% in predicting suboptimal cytoreduction were included in the ultrasound scoring system, which was then calculated for each patient.
  
  
  RESULTS
  Ultrasound allowed a virtually conclusive diagnosis of massive pelvic involvement (sensitivity, 94%; specificity, 97%), parenchymal liver metastases of any size (sensitivity, 93%; specificity, 98%) and ascites (sensitivity, 98%; specificity, 97%) and a very reliable diagnosis of peritoneal carcinomatosis (sensitivity, 91%; specificity, 88%) and omental involvement (sensitivity, 94%; specificity, 90%), whereas it was not very good at excluding parenchymal spleen metastases or splenic hilum involvement (sensitivity, 75%; specificity, 98%) and bowel mesentery involvement (sensitivity, 67%; specificity, 88%). Ultrasound-assessed peritoneal carcinomatosis, bowel mesentery involvement, omental involvement, massive pelvic involvement and ascites were included in our ultrasound score (which had a range of 0-6 points). With a cut-off value of > 5, the sensitivity and specificity of the ultrasound score with regard to prediction of suboptimal cytoreduction were 31% (20/64) and 92% (46/50), respectively.
  
  
  CONCLUSIONS
  Ultrasound examination is able to assess intra-abdominal disease in advanced ovarian cancer patients, with satisfactory concordance with laparotomic findings. Our ultrasound score can predict suboptimal cytoreduction and might be clinically useful.
authors.affiliation: Department of Obstetrics/Gynecology, Catholic University of the Sacred Heart, Rome, Italy. atesta@rm.unicatt.it
authors.forename: A C
authors.initials: AC
authors.lastname: Testa
authors.forename: M
authors.initials: M
authors.lastname: Ludovisi
authors.forename: F
authors.initials: F
authors.lastname: Mascilini
authors.forename: A
authors.initials: A
authors.lastname: Di Legge
authors.forename: M
authors.initials: M
authors.lastname: Malaggese
authors.forename: A
authors.initials: A
authors.lastname: Fagotti
authors.forename: F
authors.initials: F
authors.lastname: Fanfani
authors.forename: M G
authors.initials: MG
authors.lastname: Salerno
authors.forename: A
authors.initials: A
authors.lastname: Ercoli
authors.forename: G
authors.initials: G
authors.lastname: Scambia
authors.forename: G
authors.initials: G
authors.lastname: Ferrandina
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013160:Splenic Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D014463:Ultrasonography