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Annals of Surgical Oncology

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01-05-2015 | Gastrointestinal Oncology

Comparison of MRI and CT for Predicting the Peritoneal Cancer Index (PCI) Preoperatively in Patients Being Considered for Cytoreductive Surgical Procedures

Authors: Russell N. Low, MD, Robert M. Barone, MD, Janelle Lucero, BA

Published in: Annals of Surgical Oncology | Issue 5/2015

Abstract

Purpose

To compare the accuracy of MRI and CT for predicting the Peritoneal Cancer Index (PCI) preoperatively compared with the PCI tabulated at surgery.

Methods

Twenty-two patients underwent preoperative MRI and CT scanning followed by cytoreductive surgery for appendiceal (n = 17) and ovarian (n = 5) cancer. MR and CT examinations were retrospectively reviewed to determine the PCI. The results of these scores were compared with PCI tabulated at surgery. Patients were categorized as small volume tumor (PCI 0–9), moderate volume (PCI 10–20), and large volume (PCI > 20). Respective anatomic site scores for MRI and CT were compared with surgical findings.

Results

Compared with surgical PCI, MRI correctly categorized tumor volume in 20 (0.91) of 22 patients, including 3 of 4 patients with small volume tumor, 2 of 2 patients with moderate volume tumor, and 15 of 16 patients with large volume tumor. CT correctly categorized tumor volume in 11 of 22 (0.50) patients, including 2 of 4 patients with small-volume tumor, 2 of 2 patients with moderate volume tumor, and 7 of 16 patients with large-volume tumor. In 19 of 22 patients, CT underestimated the volume of tumor found at surgery. For all patients, the median PCI score at surgery was 33 compared with 36 for MRI and 15 for CT. Surgery confirmed 222 sites of tumor. MRI demonstrated per site sensitivity of 0.95, specificity 0.70, and accuracy 0.88. CT showed a corresponding per site sensitivity 0.55, specificity 0.86, and accuracy 0.63.

Conclusions

MRI more accurately predicts PCI preoperatively in patients undergoing evaluation for cytoreductive surgery.

Glenhen O, Gilly FN. Quantitative preoperative indicators of peritoneal surface malignancies: carcinomatosis, sarcomatosis, and peritoneal mesothelioma. Surg Oncol Clin N Am. 2003;12:649–71.CrossRef

Harmon RL, Sugarbaker PH. Prognostic indicators in peritoneal carcinomatosis from gastrointestinal cancer. Int Semin Surg Oncol. 2005;2:3. http://www.issoonline.com/content/2/1/3. Accessed 01 Oct 2013.

Sugarbaker PH, Jablonski KA. Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg. 1995;221:124–32.CrossRefPubMedCentralPubMed

Yan TD, Sim J, Morris DL. Selection of patients with colorectal peritoneal carcinomatosis for cytoreductive surgery and perioperative intraperitoneal chemotherapy. Ann Surg Oncol. 2009;14:1807–17.CrossRef

Jacquet P, Jelinek JS, Sugarbaker PH. Abdominal computed tomographic scan in the selection of patients with mucinous peritoneal carcinomatosis for cytoreductive surgery. J Am Coll Surg. 1995;181:530–8.PubMed

Esquivel J, Chua TC, Stojadinovic A, Melero JT, Levine EA, Gutman M, Howard R, Piso P, Nissan A, Gomez-Portilla A, Gonzalez-Bayon L, Gonzalez-Moreno S, Shen P, Stewart JH, Sugarbaker PH, Barone RM, Hoefer R, Morris DL, Sardi A, Sticca RP. Accuracy and clinical relevance of computed tomography scan interpretation of peritoneal cancer index in colorectal cancer peritoneal carcinomatosis: a multi-institutional study. J Surg Oncol. 2010;102:565–70.CrossRefPubMed

Coakley FV, Choi PH, Gougoutas CA, et al. Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology. 2002;223:495–500.CrossRefPubMed

Low RN, Barone RM, Lacey C, Sigeti JS, Alzate GD, Sebrechts CP. Peritoneal tumor: MR imaging with dilute oral barium and intravenous gadolinium-containing contrast agents compared with unenhanced MR imaging and CT. Radiology. 1997;204:513–20.CrossRefPubMed

Koh JL, Tan TD, Glenn D, Morris DL. Evaluation of preoperative computed tomography in estimating peritoneal cancer index in colorectal peritoneal carcinomatosis. Ann Surg Oncol. 2009;16:327–33.CrossRefPubMed

10.

Low RN, Barone RM, Gurney JM. Mucinous appendiceal neoplasms: preoperative MR staging and classification compared with surgical and histopathologic findings. Am J Roentgenol. 2008;190:656–65.CrossRef

11.

Low RN, Duggan B, Barone RM, Saleh F, Song SYT. Treated ovarian cancer: MR imaging, laparotomy reassessment, and serum CA-125 values compared with clinical outcome at 1 year. Radiology. 2005;235:918–26.CrossRefPubMed

12.

Low RN, Gurney J. Diffusion-weighted MRI (DWI) in the oncology patient: value of breathhold DWI compared to unenhanced and gadolinium-enhanced MR. J Magn Reson Imaging. 2007;25:848–58.CrossRefPubMed

13.

Low RN, Sebrechts CP, Barone RM, Muller W. Diffusion-weighted MRI of peritoneal tumors: comparison with conventional MRI and surgical and histopathologic findings–a feasibility study. Am. J. Roentgenol. 2009;193:461–70.CrossRef

14.

Kyriazi S, Collins DJ, Morgan VA, Giles SL, deSouza NM. Diffusion-weighted imaging of peritoneal disease for noninvasive staging of advanced ovarian cancer. Radiographics. 2010;30:1269–85.CrossRefPubMed

15.

Sugarbaker PH. Peritonectomy procedures. Surg Oncol Clin N Am. 2003;12:703–27.CrossRefPubMed

16.

Chua, TC, AL-Zahrani A, Saxena A, Glenn D, et al. Determining the association between preoperative computed tomography findings and postoperative outcomes after cytoreductive surgery and perioperative intraperitoneal chemotherapy for Pseudomyxoma peritonei. Ann Surg Oncol. 2011;18:1582–9.

17.

Levine EA, Stewart KH, Russell GB, Keisinger KR, Loggie BL, Shen P. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy. Experience with 501 procedures. J Am Coll Surg. 2007;2004:943–55.CrossRef

18.

Glehen O, Kwiakowsky F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy in colorectal cancer: multi-institutional study. J Clin Oncol. 2004;22:3284–92.CrossRefPubMed

19.

Low RN, Barone RM. Combined diffusion weighted and gadolinium-enhanced MRI can correctly predict peritoneal cancer index preoperatively in patient’s being considered for cytoreductive surgical procedures. Ann Surg Oncol. 2012;19:1395–401.CrossRef

20.

Low RN, Barone RM, Lee M. Surveillance MR imaging is superior to serum tumor markers for detecting early tumor recurrence in patients with appendiceal cancer treated with cytoreduction and HIPEC. Ann Surg Oncol. 2013;20:1079–81.CrossRef

Title: Comparison of MRI and CT for Predicting the Peritoneal Cancer Index (PCI) Preoperatively in Patients Being Considered for Cytoreductive Surgical Procedures
Authors: Russell N. Low, MD
Robert M. Barone, MD
Janelle Lucero, BA
Publication date: 01-05-2015
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 5/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-4041-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of MRI and CT for Predicting the Peritoneal Cancer Index (PCI) Preoperatively in Patients Being Considered for Cytoreductive Surgical Procedures

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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