Ovarian carcinoma: value of CT in predicting success of debulking surgery.
OBJECTIVE: Initial therapy for metastatic epithelial ovarian adenocarcinoma involves aggressive surgery to remove as much tumor as possible. However, this procedure is not beneficial for patients unless tumor implants can be reduced to less than 2 cm in diameter. This study was performed 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 who underwent primary surgery for ovarian carcinoma were retrospectively reviewed (18 patients had extrapelvic [stage III or IV] disease at surgery). Five regions were analyzed for evidence and extent of metastatic disease (omentum, liver, small bowel mesentery, paraaortic nodes, and diaphragm), and a score of 0-2 (see below) was assigned to each. These scores were added together for a total score of 0-10, which was compared with the surgical results. Receiver operating characteristic curve 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. RESULTS: On a 10-point preoperative CT scoring system, a score of 3 or higher identified patients whose tumors were not successfully debulked with a sensitivity of 58% (7/12) and a specificity of 100% (16/16). The area under the receiver operating characteristic curve for this system was 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 debulking surgery in women with metastatic ovarian carcinoma. A significant number of patients in whom the surgery will have no benefit can be identified.