Predictive radiological score MRI-difussion sequence of complete surgical cytoreduction in ovarian cancer

Abstract

Objectives The objective of the study was to identify a radiological score using MRI-diffusion (DW-RM) to help predict preoperatively whether a patient with advanced ovarian cancer is a candidate for primary surgery or neoadjuvant chemotherapy. Methods This retrospective study analyzed high-grade serous ovarian cancers in patients with FIGO stage III-IVA treated with primary cytoreductive surgery, who had previously undergone a DW-MRI, operated in our center from 2017 to 2021. The radiological score was prepared by two expert radiologists specialized in gynecological cancer. For the calculation of this score, the following basic peritoneal locations were established in the surgical approach: hypochondria, pelvis, diaphragms, omentum, serous small intestine, mesocolon, and the presence of ascites, assigning one point for each positive location. The criteria of unresecability, such as massive miliary or mesenteric root involvement, were excluded from the peritoneal score. Results We included 27 patients. The radiological score range was 1–8 (median 5). Optimal surgical resection was achieved in 19 patients (70.4%). In 14 (51.9%) patients, the radiologic score was <6 points; in nine patients (33.3%), it was equal to 6, and in four (14.8%), the score was higher than 6. In all patients (14/14) with a score of <6, optimal surgical resection was achieved (positive predictive value 100%). No patient with a score >6 (0/4) had achieved optimal surgical resection. In 55.6% (5/9) of patients with a score of 6 points, optimal resection was achieved, and in the remaining 44.4% (4/9), it wasn't. According to these data, establishing a cut-off point of 6 in the score, patients with DW-RM score > 6 would be candidates for treatment with neoadjuvant chemotherapy; if the score was equal to 6 or if non-massive miliary dissemination was suspected, a diagnostic laparoscopy could be considered to assess the laparoscopic score intraoperatively; if the score was <6, the patient could be a candidate for a primary cytoreduction.