Bristow et al evaluated women with advanced ovarian carcinoma using computed tomography (CT) scans of the abdomen and pelvis. They developed an index that could identify the likely outcome for a woman undergoing primary cytoreductive surgery. The authors are from the Johns Hopkins and Massachusetts General Hospitals.
Patients: Stage III or IV epithelial ovarian carcinoma
Parameters (14, with 13 from CT scan findings):
(1) peritoneal thickness (*)
(2) peritoneal implants (*)
(3) small bowel mesentery (*)
(4) large bowel mesentery (*)
(5) omentum (*)
(6) pelvic involvement (*)
(7) ascites
(8) Gynecologic Oncology Group (GOG) Performance Status
(9) suprarenal para-aortic lymph nodes (*)
(10) diaphragm or lung base
(11) inguinal canal
(12) liver
(13) porta hepatitis or gallbladder fossa
(14) infrarenal para-aortic lymph nodes
(*) items most strongly associated with surgical outcome
|
Parameter |
Finding |
Points |
|
peritoneal thickening |
yes |
2 |
|
|
no |
0 |
|
peritoneal implants |
>= 2 cm |
2 |
|
|
< 2 cm |
0 |
|
small bowel mesentery disease |
>= 2 cm |
2 |
|
|
< 2 cm |
0 |
|
large bowel mesentery disease |
>= 2 cm |
2 |
|
|
< 2 cm |
0 |
|
omentum |
extension into stomach, spleen or lesser sac |
2 |
|
|
no extension |
0 |
|
pelvis |
extension to pelvic sidewall, parametria, or hydroureter |
2 |
|
|
no extension |
0 |
|
ascites |
large volume (see on all CT cuts) |
2 |
|
|
none to moderate |
0 |
|
GOG Performance Status |
>= 2 |
2 |
|
|
< 2 |
0 |
|
suprarenal para-aortic lymph nodes |
>= 1 cm |
2 |
|
|
< 1 cm |
0 |
|
diaphragm or lung base |
>= 2 cm, or confluent plaque |
1 |
|
|
< 2 cm and no plaque |
0 |
|
inguinal canal |
inguinal canal disease or lymph nodes >= 2 cm |
1 |
|
|
no inguinal canal disease and nodes < 2 cm |
0 |
|
liver |
surface nodule >= 2 cm or any size parenchymal nodule |
1 |
|
|
surface nodules < 2 cm and no parenchymal nodules |
0 |
|
porta hepatis or gallbladder fossa |
>= 1 cm |
1 |
|
|
< 1 cm |
0 |
|
infrarenal para-aortic lymph nodes |
>= 2 cm |
1 |
|
|
< 2 cm |
0 |
predictive index =
= SUM(points for all 14 parameters)
Interpretation:
• minimum score: 0
• maximum score: 23
• An index < 4 indicates that the patient will have an optimal outcome from primary cytoreductive surgery.
• Women with a predictive index >= 4 are unlikely to have optimal primary cytoreductive surgery.
Performance:
• The performance characteristics of various cut-off points (from 1 to 10) for the index are given in Table 2, page 1538.
• For a cutoff of >= 4, the sensitivity is 100%, specificity 85%, positive predictive value 87.5%, negative predictive value 100%, accuracy 92.7%. No women would undergo unnecessary exploration, but 15% of women classed as unresectable would have residual disease <= 1 cm (inappropriately unexplored).
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
ICD-10: ,
