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Prospective Study of the Correlation Between Postoperative Computed Tomography Scan and Primary Surgeon Assessment in Patients With Advanced Ovarian, Tubal, and Peritoneal Carcinoma Reported to Have Undergone Primary Surgical Cytoreduction to Residual Disease 1 cm or Less

Dennis S. Chi, Pedro T. Ramirez, Jerrold B. Teitcher, Svetlana Mironov, Debra M. Sarasohn, Revathy B. Iyer, Eric L. Eisenhauer, Nadeem R. Abu-Rustum, Yukio Sonoda, Douglas A. Levine, Carol L. Brown, Carol Aghajanian, David M. Gershenson, William J. Hoskins, Hedvig Hricak, Richard R. Barakat

From the Gynecology Service, Department of Surgery, Department of Radiology, and Solid Tumor Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and Departments of Gynecologic Oncology and Radiology, M.D. Anderson Cancer Center, Houston, TX

Address reprint requests to Dennis S. Chi, MD, Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021; e-mail: gynbreast{at}mskcc.org or chid{at}mskcc.org

Purpose To compare surgeons' operative assessments of residual disease (RD) to those identified on postoperative computed tomography (CT) scans in patients with advanced ovarian carcinoma reported to have undergone optimal primary cytoreduction.

Patients and Methods All patients at one of two institutions, who were scheduled to have primary surgery for presumed advanced ovarian cancer, were asked to consent to a postoperative CT scan if cytoreduction to 1 cm RD was reported. CT scan findings were graded using a qualitative analysis scale from 1 (normal) to 5 (definitely malignant).

Results From January 2001 to September 2006, 285 patients were enrolled. A total of 78 patients met eligibility criteria and had postoperative CT scans. In 41 cases (52%), postoperative scan findings correlated with the surgical report of no RD more than 1 cm, and in seven cases (9%), the CT findings were indeterminate. In 10 cases (13%), more than 1 cm RD was noted by the radiologist as probably malignant, and in 20 cases (26%), definitely malignant. In these 30 cases, the radiologically reported median largest residual mass was 1.9 cm (range, 1.1 to 5.1), with RD more than 1 cm reported most commonly in the right upper quadrant (15 patients [50%]) and central abdomen (nine patients [30%]).

Conclusion There was only a 52% correlation between surgeons' assessments and postoperative CT scan evaluations of RD in patients reported to have undergone optimal cytoreduction. Further study is required to determine whether this lack of correlation is due to rapid interval tumor regrowth, RD underestimated by the surgeons, and/or overestimated by the radiologists; and to determine the clinical implications of these discrepancies.

Presented at the Society of Gynecologic Oncologists 38th Annual Meeting in San Diego, CA, March 3 to 7, 2007.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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