Preoperative assessment of peritoneal carcinomatosis in patients undergoing hyperthermic intraperitoneal chemotherapy following cytoreductive surgery.
The present study evaluates the accuracy of computed tomographic (CT) scan and positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET)/CT for the quantification of peritoneal carcinomatosis (PC) in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Data were retrospectively collected for 58 patients, who were considered for CRS and HIPEC. The predictability, sensitivity, specificity and accuracy values of FDG-PET/CT and CT were tested. Preoperative CT and FDG-PET/CT failed to detect PC in 9% and 17% of cases, respectively, with a sensitivity of 91% and 82%, a specificity of 33% and 67%, an area under the curve (AUC) of 62% and 74% and a negative likelihood ratio of 0.27 (CI.95 0.07-1.09) and 0.27 (CI.95 0.11-0.62), respectively (p=0.469). Both techniques showed a high prevalence of PC extent underestimation (CT 47% and FDG-PET/CT 43% of cases). Small bowel involvement and optimal CRS had a prevalence of 60% and 76%, respectively, and both the CT and FDG-PET/CT imaging techniques were inaccurate at predicting them (AUC 53% and 52% for small bowel involvement, and 63% and 58% for optimal CRS, respectively). In conclusion both CT and FDG-PET/CT had low preoperative staging reliability for PC, and this can strongly influence the ability to implement the correct treatment strategy for patients with PC.
Department of Surgery, S. Maria della Misericordia Hospital, 33100 Udine, Italy. enricomaria.pasqual@uniud.it.
Enrico M
EM
Pasqual
Serena
S
Bertozzi
Stefano
S
Bacchetti
Ambrogio P
AP
Londero
Stefano M M
SM
Basso
Davide A
DA
Santeufemia
Giovanni
G
Lo Re
Franco
F
Lumachi
D002277:Carcinoma / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D064847:Multimodal Imaging; D009369:Neoplasms / Q000473:pathology* / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D049268:Positron-Emission Tomography / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods
CRS; CT; HIPEC; PET; PET/CT; Peritoneal carcinomatosis; computed tomography; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; positron emission tomography