Background: The peritoneum is the preferred site of metastasis from several primary malignancies, and peritoneal carcinomatosis (PC) is one of the most significant negative prognostic indicators in patients with metastatic disease. A survival benefit has been observed for patients with PC from colorectal, ovarian, and gastric carcinomas treated by cytoreductive surgery (CRS) followed by intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). In patients undergoing this treatment modality, the strongest determinant of outcome is the residual tumor extension after CRS. Unfortunately, PC can be difficult to diagnose preoperatively by imaging studies. The aim of our study was to evaluate the role of computed tomography (CT) and 18F-2-deoxy-fluoro-D-glucose positron emission tomography/CT (PET/CT) scanning in detecting the presence and the extent of PC in patients with various advanced malignancies. Patients and Methods: A group of 47 patients (median age 61.4±11.5 years) with advanced or recurrent cancers (colorectal=26, ovarian=21, gastric=8, pseudomyxoma peritonei=3) scheduled for CRS and HIPEC underwent preoperative CT and PET/CT. The results were expressed as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. The negative (NLR) and positive (PLR) likelihood ratio were also obtained. The receiver operator characteristic (ROC) curves were drawn, and areas under the curve (AUC) were measured. The 95% confidence interval (95%CI) was also calculated, when appropriate. The results of CT scan and PET/CT were compared with the final surgical findings. Results: The sensitivity, specificity, PPV, NPV, accuracy were 91%, 33%, 93%, 29% and 69% for CT, and 82%, 67%, 95%, 33% and 71% for PET/CT, respectively. NLR and PLR were 0.27 (95%CI 0.07-1.09) and 1.37 (95%CI 0.76-2.44), while the AUC was 62 and 74 for CT and PET/CT, respectively (p=NS). Conclusions: In patients with PC undergoing surgery both PET/CT and CT showed low sensitivity, and thus they seem not to be a reliable tool in view of treatment planning. Our study demonstrates that PET/CT does not add substantially to CT scanning in the detection of this disease.
PET/CT in patients with peritoneal carcinomatosis undergoing hypertemic intraperitoneal chemotherapy (HIPEC) following cytoreductive surgery.
LUMACHI, FRANCO
2013
Abstract
Background: The peritoneum is the preferred site of metastasis from several primary malignancies, and peritoneal carcinomatosis (PC) is one of the most significant negative prognostic indicators in patients with metastatic disease. A survival benefit has been observed for patients with PC from colorectal, ovarian, and gastric carcinomas treated by cytoreductive surgery (CRS) followed by intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). In patients undergoing this treatment modality, the strongest determinant of outcome is the residual tumor extension after CRS. Unfortunately, PC can be difficult to diagnose preoperatively by imaging studies. The aim of our study was to evaluate the role of computed tomography (CT) and 18F-2-deoxy-fluoro-D-glucose positron emission tomography/CT (PET/CT) scanning in detecting the presence and the extent of PC in patients with various advanced malignancies. Patients and Methods: A group of 47 patients (median age 61.4±11.5 years) with advanced or recurrent cancers (colorectal=26, ovarian=21, gastric=8, pseudomyxoma peritonei=3) scheduled for CRS and HIPEC underwent preoperative CT and PET/CT. The results were expressed as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. The negative (NLR) and positive (PLR) likelihood ratio were also obtained. The receiver operator characteristic (ROC) curves were drawn, and areas under the curve (AUC) were measured. The 95% confidence interval (95%CI) was also calculated, when appropriate. The results of CT scan and PET/CT were compared with the final surgical findings. Results: The sensitivity, specificity, PPV, NPV, accuracy were 91%, 33%, 93%, 29% and 69% for CT, and 82%, 67%, 95%, 33% and 71% for PET/CT, respectively. NLR and PLR were 0.27 (95%CI 0.07-1.09) and 1.37 (95%CI 0.76-2.44), while the AUC was 62 and 74 for CT and PET/CT, respectively (p=NS). Conclusions: In patients with PC undergoing surgery both PET/CT and CT showed low sensitivity, and thus they seem not to be a reliable tool in view of treatment planning. Our study demonstrates that PET/CT does not add substantially to CT scanning in the detection of this disease.
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