Imaging diagnostics in ovarian cancer: magnetic resonance imaging and a scoring system guiding choice of primary treatment.

OBJECTIVE: To analyze the ability of magnetic resonance imaging (MRI) and systematic evaluation at surgery to predict optimal cytoreduction in primary advanced ovarian cancer and to develop a preoperative scoring system for cancer staging.

STUDY DESIGN: Preoperative MRI and standard laparotomy were performed in 99 women with either ovarian or primary peritoneal cancer. Using univariate and multivariate logistic regression analysis of a systematic description of the tumor in nine abdominal compartments obtained by MRI and during surgery plus clinical parameters, a scoring system was designed that predicted non-optimal cytoreduction.

RESULTS: Non-optimal cytoreduction at operation was predicted by the following: (A) presence of comorbidities group 3 or 4 (ASA); (B) tumor presence in multiple numbers of different compartments, and (C) numbers of specified sites of organ involvement. The score includes: number of compartments involved (1-9 points), >1 subdiaphragmal location with presence of tumor (1 point); deep organ involvement of liver (1 point), porta hepatis (1 point), spleen (1 point), mesentery/vessel (1 point), cecum/ileocecal (1 point), rectum/vessels (1 point): ASA groups 3 and 4 (2 points). Use of the scoring system based on operative findings gave an area under the curve (AUC) of 91% (85-98%) for patients in whom optimal cytoreduction could not be achieved. The score AUC obtained by MRI was 84% (76-92%), and 43% of non-optimal cytoreduction patients were identified, with only 8% of potentially operable patients being falsely evaluated as suitable for non-optimal cytoreduction at the most optimal cut-off value. Tumor in individual locations did not predict operability.

CONCLUSION: This systematic scoring system based on operative findings and MRI may predict non-optimal cytoreduction. MRI is able to assess ovarian cancer with peritoneal carcinomatosis with satisfactory concordance with laparotomic findings. This scoring system could be useful as a clinical guideline and should be evaluated and developed further in larger studies.