|
Back to 2015 Annual Meeting Program
Correlation of Radiologic With Surgical Pci Scores in Patients With Pseudomyxoma Peritonei: How Well Can WE Predict Resectability?
Awais Ashfaq*1, Krsitina Flicek1, Christine Menias2, C Daniel Johnson2, Sanjay Bagaria1, Nabil Wasif1
1Surgery, Mayo Clinic, Phoenix, AZ; 2Radiology, Mayo Clinic, Phoenix, AZ
INTRODUCTION:
Pseudomyxoma peritonei (PMP) arises from primary or secondary peritoneal cancer and is treated with complete surgical removal of disease. Suitability for surgery is based on a peritoneal cancer index (PCI) score, with a PCI >20 usually representing unresectable disease.
AIMS:
Compare pre-operative imaging with surgical findings based on PCI.
METHODS:
All cases of patients with PMP undergoing surgical debulking and hyperthermic intra-operative chemotherapy (HIPEC) between 2010-2014. PCI scores were obtained from surgical operative reports. Two staff radiologists blinded to surgical PCI scores retrospectively reviewed 39 CTs and 3 MRIs to calculate corresponding radiologic PCI scores for each patient. Correlation between radiologic PCI and surgical PCI was assessed using Spearman's rho correlation coefficients.
RESULTS:
42 patients had a mean surgical PCI ± SEM score of 15.1 ± 1.3 and mean radiologic PCI of 15.5 ±1.5. The majority of our study population were female (60%) and White (86%). The most common tumor histologies were appendiceal (60%) and colon (33%) adenocarcinoma and the majority were of low tumor grade (67%). Correlation between both radiologic PCI scores was 0.71, and correlation between individual radiologists and surgical PCI was 0.59 and 0.62, respectively (all p<0.001). This correlation with surgical PCI improved to 0.64 (p <0.001) when mean radiologic PCI score was used, and improved further to 0.65 (<0.001) when only good quality studies were considered; Figure 1. For the entire cohort, 78% achieved a CC0/CC1 cytoreduction, with the remainder being deemed unresectable (CC2/3). In patients with a radiologic PCI >20, 58% had unresectable disease, whereas the remainder achieved adequate cytoreduction.
CONCLUSIONS:
Good quality cross-sectional imaging, combined with over-reading and formal assessment of all components of the PCI score yields the best correlation with actual surgical findings. Using a cut off radiologic PCI score >20 to assess resectability is problematic as almost half of these patients were still able to undergo adequate cytoreduction. Better assessment of resectability is needed pre-op, either by refinement of the PCI criterion or routine staging laparoscopy.
Back to 2015 Annual Meeting Program
|
