title: The use of CT findings to predict extent of tumor at primary surgery for ovarian cancer.
abstract: BACKGROUND
  High tumor dissemination (HTD) is a major risk factor for serious morbidity after primary ovarian cancer (OC) surgery, particularly in medically compromised patients. We performed a pilot study of whether CT findings could predict extent of disease and surgical complexity necessary in advanced OC.
  
  
  METHODS
  Preoperative CT images for patients with advanced OC from 1997-2003 were evaluated for rigorously defined disease-related findings and compared to both the findings at exploration and the required surgical procedures. Associations were assessed by the chi-square test.
  
  
  RESULTS
  Forty-six cases met inclusion criteria. Mean age was 66.4y, and 76% had residual disease (RD) 1cm or less. CT and surgical findings correlated (sensitivity/specificity) as follows: diaphragm disease (48%/100%); surface liver (100%/93%); omental cake (72%/65%); any sigmoid involvement (54%/100%); ascites (44%/100%); extra-pelvic large bowel involvement (29%/91%). When diaphragm disease and omental cake were present, HTD was found in all cases (positive predictive value and specificity=100%, sensitivity 48%). For CT findings of liver, large bowel and spleen involvement there was a strong trend toward resection (P=0.001, P=0.06 and P=0.06, respectively).
  
  
  CONCLUSIONS
  The findings of diaphragm disease and omental cake on CT scan are highly predictive for high tumor dissemination (HTD) and thus likelihood of extensive surgery required to achieve low residual disease. In addition, multiple CT findings correlate strongly with the need for higher surgical complexity which should facilitate preoperative planning and/or triage to specialized centers. These preliminary data suggest specific CT findings can be used to optimize treatment planning.
authors.affiliation: Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Glaser
authors.forename: Michelle
authors.initials: M
authors.lastname: Torres
authors.forename: Bohyun
authors.initials: B
authors.lastname: Kim
authors.forename: Giovanni
authors.initials: G
authors.lastname: Aletti
authors.forename: Amy
authors.initials: A
authors.lastname: Weaver
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
authors.forename: Lynn
authors.initials: L
authors.lastname: Hartmann
authors.forename: William
authors.initials: W
authors.lastname: Cliby
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Cytoreduction; Outcome assessment; Ovarian neoplasms; Radiologic imaging