Computed tomography and second-look surgery in ovarian cancer patients. Correlation, actual role and limitations of CT scan

Abstract

Computed tomography (CT scan) was performed on 58 clinically disease-free ovarian cancer patients. The scans were correlated with the results obtained at a subsequent second-look laparotomy. The sensitivity was 0.47, the specificity 0.87, diagnostic accuracy 0.63, positive predictive value 0.84 and negative 0.53. Undetected microscopic disease was classified as a false-negative result. Sensitivity was poor for omental, mesenteric and peritoneal implants and for bowel infiltration, good for lymphnodal involvement and abdominal mass and decisively good for intrahepatic and plenic metastases of ovarian cancer. Due to a still high false-negative rate a normal CT scan does not provide sufficiently accurate diagnostic information to replace a second-look laparotomy. But on the other hand, due to a high specificity, the usefulness of CT can be limited to approximately 27% of patients, with true-positive findings, who might have been saved surgical reexploration. Adjunct studies such as immunoscintigraphy with radiolabelled monoclonal antibodies and measurement of tumor markers further increase its diagnostic accuracy.