A Prospective Analysis Assessing Accuracy of Contrast-enhanced Computed Tomography (CECT) in Estimation of Peritoneal Carcinomatosis Index (PCI) Score and Its Correlation with Intraoperative Findings in Ovarian Cancer

Abstract

Background: Ovarian carcinoma, the third leading cancer affecting women worldwide, presents in advanced stages in nearly 75% of cases, where cytoreductive surgery (CRS) with platinum-based chemotherapy remains the standard treatment, and contrast-enhanced computed tomography (CECT) plays an important role in estimating the peritoneal carcinomatosis index (PCI) with correlation to intraoperative findings. Objective: The present study assess the correlation between radiological PCI and intraoperative surgical PCI. Also, to estimate sensitivity, specificity, PPV and NPV, and accuracy of CECT in determining pre-operative disease burden. Methods: This is a prospective, single-center observational cohort study that was done on 50 patients with advanced ovarian cancer (FIGO stage 2b and above) and recurrent ovarian tumors who underwent preoperative CECT followed by CRS +/- HIPEC at our center from August 2021 to July 2023. The total Radiological PCI and Surgical PCI were recorded and tabulated for comparison. Results: The correlation between the total Radiological PCI and Surgical PCI using the Spearman rank correlation coefficient showed a positive correlation of 0.403 and a significant p-value of 0.004. The highest sensitivity has been found in the left upper quadrant (91.7%) and epigastrium (85.6%), while the lowest sensitivity in detecting deposits was in the left iliac fossa (30%) and distal ileum (33.3%). Similar trends in diagnostic accuracy have been observed, i.e., for the left upper quadrant (84%) and the distal ileum (48%). The overall sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 53.11%, 76.13%, 61.7%, 69.16%, and 66.46 %, respectively, on taking all quadrant observations into account. Conclusions: The correlation between the radiological PCI and surgical PCI is good. Thus, it is especially useful in patients with high-volume disease (PCI of more than 15) and help in predicting the resectability of the disease. However, certain areas, like the proximal and distal segments of the small bowel and left iliac fossa, do not show a good correlation.