Preoperative evaluation of epithelial ovarian cancer with multidetector computed tomography and its correlation with surgical outcome

16051 Background: In the management of epithelial ovarian cancer (EOC), optimum debulking surgery (residual tumour of 1 cm or less) is the most important prognostic factor and is associated with higher survival We conducted a prospective study to evaluate the role of Multidetector (MD) CT scan to predict optimal debulking in advanced EOC. Methods: Between December, 2004 and October, 2006, 38 previously untreated patients (median age-50 years, range 26 to 70) were evaluated with contrast- enhanced MD CT scan of abdomen and pelvis. All CT scans were performed on four-slice MD CT scanner with thin slice image acquisition. Multiplanar coronal, sagital or oblique images were constructed and all images were reviewed by at least 2 radiologists. The extent of disease was determined and mapped for all areas of abdomen and pelvis. Patients underwent primary debulking surgery in which total abdominal hysterectomy, bilateral salphingo-oophorectomy, omentectomy and optimal cytoreduction was done. CT scan films were reviewed and compared with surgical findings. A CT scan scoring system was developed to predict the optimum debulking using 10 parameters: ascites, pelvic, peritoneal deposits, large bowel, small bowel, omentum, diaphragm, liver, lymphadenopathy and lesser sac. Each factor was assigned a score of 0 to 2. The statistical analysis was done using SPSS version 11 and EpiInfo 6 software. Results: The mean interval between CT scan and surgery was 11 days. 18 of 38 patients had a CT score = 7; all 18 had sub-optimal debulking. Of remaining 20 patients with CT score <7, 17(44.7%) had optimum and 3 had sub-optimal cytoreduction. The sensitivity and specificity was 85.7% (95% CI 62.6–96.2) and 100% (95% CI 77.1–100), respectively. It had positive predictive value of 100% and negative predictive value of 85% with accuracy of 92% in identification of patients who would not benefit from surgery. Presence of tumor at gall bladder fossa, porta hepatis, ligament teres, spleen , stomach, pancreas, lesser sack and pelvic side walls was associated with sub-optimal debulking. Conclusions: Pre-operative CT scan scoring helps to identify patients who are likely to have sub-optimal debulking and may be candidates for neoadjuvant chemotherapy No significant financial relationships to disclose.