title: Accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC).
abstract: OBJECTIVE
  To evaluate the accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent a peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) after neoadjuvant chemotherapy to obtain a pre-surgery prognostic evaluation and a prediction of optimal cytoreduction surgery.
  
  
  METHODS
  Pre-HIPEC CT examinations of 43 patients with advanced ovarian cancer after neoadjuvant chemotherapy were analyzed by two radiologists. The PCI was scored according to the Sugarbaker classification, based on lesion size and distribution. The results were compared with macroscopic and histologic data after peritonectomy and HIPEC. To evaluate the accuracy of MDCT to detect and localize peritoneal carcinomatosis, both patient-level and regional-level analyses were conducted. A correlation between PCI CT and histologic values for each patient was searched according to the PCI grading.
  
  
  RESULTS
  Considering the patient-level analysis, CT shows a sensitivity, specificity, PPV, NPV, and an accuracy in detecting the peritoneal carcinomatosis of 100 %, 40 %, 93 % 100 %, and 93 %, respectively. Considering the regional level analysis, a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 72 %, 80 %, 66 %, 84 %, and 77 %, respectively were obtained for the correlation between CT and histology.
  
  
  CONCLUSIONS
  Our results encourage the use of MDCT as the only technique sufficient to select patients with peritoneal carcinomatosis for cytoreductive surgery and HIPEC on the condition that a CT examination will be performed using a dedicated protocol optimized to detect minimal peritoneal disease and CT images will be analyzed by an experienced reader.
authors.affiliation: Section of Radiological Sciences, Department of Medical, Surgical and Neuro Sciences, University of Siena, Viale Bracci 10, 53100, Siena, Italy, mamazzei@gmail.com.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Mazzei
authors.forename: Leila
authors.initials: L
authors.lastname: Khader
authors.forename: Alfredo
authors.initials: A
authors.lastname: Cirigliano
authors.forename: Nevada
authors.initials: N
authors.lastname: Cioffi Squitieri
authors.forename: Susanna
authors.initials: S
authors.lastname: Guerrini
authors.forename: Beatrice
authors.initials: B
authors.lastname: Forzoni
authors.forename: Daniele
authors.initials: D
authors.lastname: Marrelli
authors.forename: Franco
authors.initials: F
authors.lastname: Roviello
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: Mazzei
authors.forename: Luca
authors.initials: L
authors.lastname: Volterrani
mesh_terms: D000328:Adult; D000368:Aged; D010478:Chemotherapy, Cancer, Regional Perfusion; D003287:Contrast Media; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007479:Iopamidol; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D007479:Iopamidol