Ultrasound evaluation of intra-abdominal sites of disease to predict the likelihood of suboptimal cytoreduction in advanced ovarian cancer: a propective study

OBJECTIVE: This prospective study aimed at analyzing the ability of ultrasound to evaluate the extension of the disease and to predict the likelihood of suboptimal cytoreduction in advanced ovarian cancer patients. METHODS: 147 patients with advanced ovarian cancer were consecutively enrolled. All patients underwent standard laparotomy, and maximal surgical effort was attempted. The sonographic parameters used to set up scoring system predicting suboptimal cytoreduction were: peritoneal carcinomatosis, bowel mesentery involvement, omental involvement, massive pelvic involvement, ascites, liver and/or spleen metastases. Sonographic parameters achieving a negative predictive value>50%, and a positive predictive value>50% in predicting suboptimal cytoreduction were included in the ultrasound score. RESULTS: Ultrasound offered a virtually conclusive diagnosis of massive pelvic involvement (sensitivity = 94%, specificity = 97%), parenchymal liver metastases any size (sensitivity = 93%, specificity = 98%) and ascites (sensitivity = 98%, specificity = 97%); a very reliable diagnosis of peritoneal carcinomatosis (sensitivity = 91%, specificity = 88%) and omental involvement (sensitivity = 94%, specificity = 90%), whereas it was not very good at excluding parenchymal spleen metastases or splenic hilus involvement (sensitivity = 75%, specificity= 98%) and bowel mesentery involvement (sensitivity= 67%, specificity = 88%). Ultrasound-assessed peritoneal carcinomatosis, bowel mesentery involvement, omental involvement, massive pelvic involvement and ascites were included in the ultrasound score (range from 0 to 6). With the selected cut-off value (>5), the sensitivity and specificity with regard to suboptimal cytoreduction of the ultrasound score were 31% (20/64) and 92% (46/50)". CONCLUSIONS: Ultrasound examination is able to assess intra-abdominal disease in advanced ovarian cancer with a satisfying concordance with laparotomic findings. Our ultrasound score can predict suboptimal cytoreduction and might be clinically useful.