OVARIAN-CARCINOMA - VALUE OF CT IN PREDICTING SUCCESS OF DEBULKING SURGERY

OBJECTIVE. Initial therapy for metastatic epithelial ovarian adenocarc inoma involves aggressive surgery to remove as much tumor as possible, However, this procedure is not beneficial for patients unless tumor i mplants can be reduced to less than 2 cm in diameter. This study was p erformed to determine whether CT can be used to predict the success of debulking surgery and thereby spare some patients from an unnecessary operation. MATERIALS AND METHODS. Preoperative CT scans of 28 women w ho underwent primary surgery for ovarian carcinoma were retrospectivel y reviewed (18 patients had extrapelvic [stage III or IV] disease at s urgery). Five regions were analyzed for evidence and extent of metasta tic disease (omentum, liver, small bowel mesentery, paraaortic nodes, and diaphragm), and a score of 0-2 (see below) was assigned to each. T hese scores were added together for a total score of 0-10, which was c ompared with the surgical results. Receiver operating characteristic c urve analysis was used to assess the ability of the scoring system to predict which patients would benefit from tumor debulking. Patient age , serum CA-125 level, and amount of ascites were also examined. RESULT S. On a 10-point preoperative CT scoring system, a score of 3 or highe r identified patients whose tumors were not successfully debulked with a sensitivity of 58% (7/12) and a specificity of 100% (16/16), The ar ea under the receiver operating characteristic curve for this system w as 0.94. The use of additional parameters, such as extent of ascites, serum CA-125 level, or age. did not improve accuracy. CONCLUSION. Our results show that CT can be used to predict the success of primary deb ulking surgery in women with metastatic ovarian carcinoma. A significa nt number of patients in whom the surgery will have no benefit can be identified.