Comparative study of pre-operative CT scan and per-operative findings in carcinoma ovary

Reshika Naik, Suchitra R, Balakrishna Naik


Background: Initial therapy for ovarian carcinoma involves aggressive surgery to remove as much tumor as possible. However, this procedure is not beneficial for patients unless tumor is optimally debulked. This study was performed to compare the CT scan findings and per-operative findings and to determine whether CT can be used to predict the success of debulking surgery.

Methods: A retrospective and prospective   study was conducted from 2011 to 2013 comparing pre operative CT scan findings and per operative findings of patients diagnosed with carcinoma ovary. 59 patients met the inclusion criteria. Five radiographic features were analysed and a  score of 0 to 2 was assigned to each. These scores were added and compared to the surgical results.

Results: We found that CT was highly sensitive in the diagnosis of retroperitoneal lymph node, ascites and omental involvement with sensitivity of 85.7%, 100% and 73.6% respectively. Sensitivity to detect peritoneal deposits and sub diaphragm deposits was 60% and 16.6% respectively. Specificity was uniformly greater than 85% for all parameters except ascites and retro peritoneal lymph nodes which was 71.4% and 54.8%. On a 10-point preoperative CT scoring system, a score of ≥3 identified patients whose tumors were not successfully debulked with a sensitivity of 79% and a specificity of 93%.

Conclusions: CT scan is highly sensitive and specific in identifying metastatic disease and can be used as a pre-operative tool in advanced carcinoma ovary to guide further management.


Ovarian carcinoma, CT scan, Cytoreduction, Ca 125

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Scully RE, Young RH, Clement PB. Tumors of ovary, maldeveloped gonads, fallopian, tube, and broad ligament. Atlas of tumor pathology, fascicle 23 3rd series Washington, DC: Armed Forces Institute of pathology. 1998:1-168.

Jemal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer statistics, 2003. CA Cancer J clin. 2003;53:5-26.

Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a metaanalysis. J Clin Oncol. 2002;20(5):1248-59.

du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I , Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Grouped’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). 2009;115(6):1234-44.

Vergote I, Trope CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010;363(10):943-5.

Vergote I, De Wever I, Tjalma W, Van Gramberen M, Decloedt J, van Dam P. Neoadjuvant chemotherapy or primary debulking surgery in advanced ovarian carcinoma: a retrospective analysis of 285 patients. Gynecol Oncol. 1998;71(3):431-6.

Hoskins WJ, McGuire WP, Brady MF, Homesley HD, Creasman WT, Berman M, et al. The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol. 1994;170(4):974-9.

Schwartz PE, Chambers JT, Makuch R. Neoadjuvant chemotherapy for advanced ovarian cancer. Gynecol Oncol. 1994;53(1):33-7.

Vergote I, Amant F, Kristensen G, Ehlen T, Reed NS, Casado A. Primary surgery or Neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer. Eur J Cancer. 2011;47(Suppl 3):S88-92.

Vernooij F, Heintz P, Witteveen E, van der Graaf Y. The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: a systematic review. Gynecol Oncol. 2007;105(3):801-8.

Goff BA, Matthews BJ, Larson EH, Andrilla CH, Wynn M, Lishner DM, et al. Predictors of comprehensive surgical treatment in patients with ovarian cancer. Cancer. 2007;109(10):2031-42.

Carney ME, Lancaster JM, Ford C, Tsodikov A, Wiggins CL. A population-based study of patterns of care for ovarian cancer: who is seen by a gynecologic oncologist and who is not? Gynecol Oncol. 2002;84(1):36-42.

Bristow RE, Duska LR, Lambrou NC, Fishman EK, O’Neill MJ, Trimble EL, et al. A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography. Cancer. 2000;89(7):1532-40.

Axtell AE, Lee MH, Bristow RE, Dowdy SC, Cliby WA, Raman S, et al. Multi-institutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoreduction in patients with advanced ovarian cancer. J Clin Oncol. 2007;25(4):384-9.

Dowdy SC, Mullany SA, Brandt KR, Huppert BJ, Cliby WA. The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma cancer. 2004;101(2):346-52.

Meyer JI, Kennedy AW, Friedman R, Ayoub A, Zepp RC. Ovarian carcinoma: value of CT in predicting success of debulking surgery. AJR Am J Roentgenol. 1995;165:875-8.

Nelson BE, Rosenfield AT, Schwartz PE. Preoperative abdominopelvic computed tomographic prediction of optimal cytoreduction in epithelial ovarian carcinoma. J Clin Oncol. 1993;11:166–72.

Guidozzi F, Sonnendecker EWW. Evaluation of preoperative investigations in patients admitted for ovarian primary cytoreductive surgery. Gynecol Oncol. 1991;40:244-7.

Kivinen, Kuoppala T, Leppilampi M, Vuori J, Kauppila A. Tumor-associated antigen CA 125 before and during treatment of ovarian carcinoma. Obstet Gynecol. 1986;67:414-6.

Buist M, Golding R, Burger Cw. Comparative evaluation of diagnostic methods in ovarian carcinoma with emphasis on CT and MRI. Gynecol Oncol. 1994;52:191-8.

Everett E, Heuser C, Pastore L, Anderson W, Rice L, Irvin W,et al. Predictors of suboptimal surgical cytoreduction in women treated with initial cytoreductive surgery for advanced stage epithelial ovarian cancer. Am J Obstet Gynecol. 2005:193(2):568-74.

Risum S, HA.gdall C, Loft A, Berthelsen A, HA.gdall E, Nedergaard L et al. Prediction of suboptimal primary cytoreduction in primary ovarian cancer with combined positron emission tomography/computed tomography a prospective study. Gynecol Oncol. 2008;108(2):265-70.

Shimizu Y, Kamoi S, Amada S, Hasumi K, Akiyama F, Silverberg S. Toward the Development of a Universal Grading System for Ovarian Epithelial Carcinoma. Gynecol Oncol. 1998;70(1):2-12.

Cookley F. Staging ovarian cancer. Role of imaging. Radiol Cin N Am. 2002;40(3):609-36.

Ascher SM, Imauka I, Jha RC. Tumours of adnexa. Bragg DG, Rubin P, Hricak H. Oncologic Imaging, 2nd ed. Phildelphia, WB Saunders. 2002;549-74.

Urban BA , Fishman EK. Helical CT of the female pelvis. Radiol Clin N Am. 1995;33:933-40.

Forstner R, Hricak H, Occhipinti K, Powell C, Frankel S, Stern J. Ovarian cancer: staging with CT and MR imaging. Radiology. 1995;197(3):619-26.

Kurtz A, Tsimikas J, Tempany C, Hamper U, Arger P, Bree R et al. Diagnosis and Staging of Ovarian Cancer: Comparative Values of Doppler and Conventional US, CT, and MR Imaging Correlated with Surgery and Histopathologic Analysis report of the Radiology Diagnostic Oncology Group1. Radiology. 1999;212(1):19-27.

G Ferrandina, G Sallustio, A Fagotti, G Vizzielli, A Paglia, E Cucci, et al. Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial. BJC. 2009:101:1066-73.

Gerestein CG, Eijkemans MJ,Bakker J, Elgersma OE,Van der burg M, Kooi GS, et al. Nomogram for Suboptimal Cytoreduction at Primary Surgery for Advanced Stage Ovarian Cancer. Anticancer research. 2011;31:4043-50.

Mousavi A, Mazhari M, Guilani M, Ghaemmaghami F, Behtash N, Akhavan S. Can primary optimal cytoreduction be predicted in advanced epithelial ovarian cancer preoperatively? World J Surg Oncol. 2010;8(1):11.

Glaser G, Torres M, Kim B, Aletti G, Weaver A, Mariani A et al. The use of CT findings to predict extent of tumor at primary surgery for ovarian cancer. Gynecol Oncol. 2013;130(2):280-3.

Memarzadeh S, Lee S, Berek J, Farias-Eisner R. CA125 levels are a weak predictor of optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer. Int J Gynecol Cancer. 2003;13(2):120-4.

Gemer O, Lurian M, Gdalevich M, Kapustian V, Piura E, Schneider D, et al. A multicenter study of CA 125 level as a predictor of non-optimal primary cytoreduction of advanced epithelial ovarian cancer. Eur J Surg Oncol. 2005;31(9):1006-10.

Barlow T, Przybylski M, Schilder J, Moore D, Look K. The utility of pre-surgical CA125 to predict optimal tumor cytoreduction of epithelial ovarian cancer. Int J Gynecol Cancer. 2006;16(2):496-500.

Vorgias G, Iavazzo C, Savvopoulos P, Myriokefalitaki E, Katsoulis M, Kalinoglou N et al. Can the preoperative Ca-125 level predict optimal cytoreduction in patients with advanced ovarian carcinoma? A single institution cohort study. Gynecol Oncol. 2009;112(1):11-5.