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)

PURPOSE The extent of peritoneal dissemination at the time of surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) was scored according to the peritoneal cancer index (PCI) that is considered a prognostic factor in patients with ovarian cancer. The aim of our work has been to evaluate the accuracy of MDCT in the preoperativehas been to evaluate the accuracy of MDCT in the preoperative definition of PCI in patients with advanced ovarian cancer who underwent peritonectomy and HIPEC after neoadjuvant CHT, in order to obtain a pre-surgery prognostic evaluation and a prediction of optimal cytoreduction. METHOD AND MATERIALS Pre-surgery CT examinations of 27 patients (2 performed with a 4 MDCT, 6 performed with a 16 MDCT and 19 with a 64 MDCT, with a mean age 56, range 40-71) with advanced ovarian cancer after neoadjuvant CHT were evaluated, retrospectively and in a blind fashion, by a Radiologist with expertise in the oncologic field. The PCI was scored following the Sugarbaker classification, based on lesion size and distribution (score value ranging from 1 to 39). The results were compared with macroscopic data after peritonectomy. RESULTS In 10/27 (37.03%) a complete correlation between the PCI score extrapolated with MDCT and the surgical PCI was found. If the PCI values were stratified in three groups (grade 1 = 0; grade 2 ≥1 <6 and grade 3 ≥6) a correlation with MDCT results of 100%, 80% and 93% respectively was found. In the 75% of the patients a correct identification of bowel mesentery involvement was realized. CONCLUSION MDCT is an accurate technique to obtain an appropriate preoperative definition of PCI before peritonectomy and HIPEC. CT examination with fluid distension of the bowel loops can therefore improve diagnostic performance. CLINICAL RELEVANCE/APPLICATION MDCT is an accurate technique to obtain a preoperative definition of peritoneal cancer index and therefore a pre-surgey prognostic evaluation in patient with ovarian cancer