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. 2025 Apr 11;23(1):138.
doi: 10.1186/s12957-025-03775-5.

What is the accuracy, sensitivity and specificity of the radiological peritoneal cancer index in repeat cytoreductive surgery: a retrospective study

Celine Garrett  1   2 , Louise Sun  3 , Raymond Hayler  3   4 , Ruwanthi Wijayawardana  3 , Nima Ahmadi  3 , Mina Sarofim  3 , David L Morris  3   4
Affiliations

What is the accuracy, sensitivity and specificity of the radiological peritoneal cancer index in repeat cytoreductive surgery: a retrospective study

Celine Garrett et al. World J Surg Oncol. .

Abstract

Background: Repeat cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) (rCRS-HIPEC) has improved the long-term survival of select patients with acceptable perioperative morbidity and mortality. The pattern of peritoneal disease recurrence is critical in determining eligibility for rCRS-HIPEC. This study evaluated the accuracy, sensitivity and specificity of the radiological peritoneal cancer index (PCI) across different imaging modalities in rCRS-HIPEC patients.

Methods: This was a retrospective study on patients with peritoneal disease recurrence who underwent rCRS-HIPEC between January 2022 to December 2023. The accuracy, sensitivity, and specificity of the radiological PCI in predicting the surgical PCI was calculated overall and for each imaging modality at each abdominal region.

Results: 32 patients were included in this study. The accuracy, sensitivity and specificity of the overall radiological PCI was 63.0%, 30.8% and 79.9%, respectively. Accuracy (67.5 vs. 62.6%) and specificity (84.8% vs. 75.8%) were higher in FDG-PET versus CT. The sensitivities of all imaging modalities were low (CT 34.9%, FDG-PET 33.3%). FDG-PET and CT had high sensitivities in detecting pelvic disease (80% and 87.5%) but low sensitivities in identifying small bowel (25-33.3% for both modalities) and epigastric disease (25% and 0%). For each abdominal region, the difference between radiological and surgical PCI did not differ significantly based on imaging modality.

Conclusions: Overall, the radiological PCI has a good specificity in rCRS-HIPEC patients and should be used to guide perioperative decision-making. FDG-PET had superior accuracy and specificity in comparison to CT in detecting peritoneal disease recurrence.

Keywords: Computed tomography; Magnetic resonance imaging; Peritoneal cancer index; Positron emission topography; Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The research related to human use has complied with all the relevant national regulations, institutional policies, and in accordance with the tenets of the Helsinki Declaration, and has been approved by the South Eastern Sydney Local Health District Human Research Ethics Committee as part of “Clinical studies in Abdominal and Peritoneal Cancers”, QAQI/18/078. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The division of the abdomen into thirteen regions as part of the PCI score
See this image and copyright information in PMC

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