Diagnostic accuracy of MDCT for preoperative peritoneal cancer index estimation in advanced ovarian cancer undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC): a Sugarbaker-based analysis.

Abstract

Integration of hyperthermic intraperitoneal chemotherapy (HIPEC) into interval cytoreductive surgery (CRS) has improved recurrence-free and overall survival in patients with advanced ovarian cancer. Multidetector computed tomography (MDCT) is routinely used for preoperative evaluation via the peritoneal cancer index (PCI). This study aimed to assess the diagnostic accuracy of MDCT in predicting intraoperative PCI. This retrospective, single-center study analyzed 69 patients with advanced ovarian cancer who underwent MDCT within 90 days prior to CRS with HIPEC between April 2014 and April 2023. Peritoneal lesions were scored using the Sugarbaker system across 13 regions, assigning lesion size (LS) scores from 0 to 3. MDCT-derived PCI was compared with intraoperative PCI. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Peritoneal deposits were identified in 382 out of 897 regions (42.6%) during surgery. MDCT achieved 60.7% sensitivity and 91.3% specificity for differentiating LS 0-1 vs. 2-3, and 52.1% sensitivity and 87.4% specificity for LS 0 vs. 1-3. Overall accuracy was 84.1% and 72.4% for these respective thresholds. A strong correlation was observed between MDCT-PCI (7.3 ± 6.1) and intraoperative PCI (9.8 ± 6.9) (r = 0.83, p < 0.05). Optimal cytoreduction was achieved in 94% of patients. MDCT reliably estimates peritoneal cancer index and guides surgical planning in HIPEC candidates with extensive disease, but its sensitivity for small or subcentimeter lesions, especially in the small bowel, remains limited, necessitating adjunctive imaging modalities. Question Can contrast-enhanced multidetector CT accurately estimate the Sugarbaker peritoneal cancer index preoperatively to guide surgical selection in advanced ovarian cancer undergoing HIPEC? Findings Dual-threshold MDCT analysis demonstrated a strong correlation with intraoperative PCI (r = 0.83) and achieved 84.1% accuracy for identifying clinically significant peritoneal disease. Clinical relevance Preoperative MDCT-based PCI assessment supports surgical planning and prognostic stratification in advanced ovarian cancer considered for HIPEC. Although sensitivity is limited for small bowel lesions, MDCT provides clinically useful tumor burden estimation to guide treatment selection.