MDCT对晚期卵巢癌HIPEC术前腹膜癌指数的诊断准确性：基于Sugarbaker的分析
本研究回顾性分析69例晚期卵巢癌患者，评估MDCT术前预测术中腹膜癌指数（PCI）的诊断准确性。MDCT与术中PCI强相关（r=0.83），鉴别LS 0-1 vs. 2-3的敏感度60.7%、特异度91.3%，准确率84.1%；但对小肠小病灶敏感度有限。
要点
- MDCT术前PCI与术中PCI强相关（r=0.83），可用于手术规划。
- 鉴别LS 0-1 vs. 2-3的准确率84.1%，特异度91.3%，敏感度60.7%。
- 对小肠或亚厘米病灶敏感度有限，需结合其他影像手段。
核心结论
- MDCT能可靠估计腹膜癌指数，指导广泛病变患者的HIPEC手术规划，但对小肠小病灶敏感度有限。
研究设计与样本
- 回顾性单中心研究，纳入69例晚期卵巢癌患者，于CRS+HIPEC前90天内行MDCT。
- 采用Sugarbaker系统对13个区域进行病灶大小评分（0-3分），比较MDCT-PCI与术中PCI。
关键影像表现/征象
- 术中897个区域中382个（42.6%）发现腹膜种植灶。
- MDCT-PCI均值7.3±6.1，术中PCI均值9.8±6.9，两者强相关（r=0.83，p<0.05）。
- 94%患者实现最佳肿瘤减灭。
诊断标准与关键数值
- 鉴别LS 0-1 vs. 2-3：敏感度60.7%，特异度91.3%，准确率84.1%。
- 鉴别LS 0 vs. 1-3：敏感度52.1%，特异度87.4%，准确率72.4%。
临床应用与阅片要点
- 术前MDCT-PCI可用于评估肿瘤负荷、支持手术选择和预后分层。
- 需注意对小肠及亚厘米病灶的漏诊风险，必要时补充其他影像检查。
局限性
- 回顾性单中心设计，样本量69例，可能存在选择偏倚。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVES: Integration of hyperthermic intraperitoneal chemotherapy (HIPEC) into interval cytoreductive surgery (CRS) has improved recurrence-free and overall survival in patients with advanced ovarian cancer. Multidetector computed tomography (MDCT) is routinely used for preoperative evaluation via the peritoneal cancer index (PCI). This study aimed to assess the diagnostic accuracy of MDCT in predicting intraoperative PCI.
MATERIALS AND METHODS: This retrospective, single-center study analyzed 69 patients with advanced ovarian cancer who underwent MDCT within 90 days prior to CRS with HIPEC between April 2014 and April 2023. Peritoneal lesions were scored using the Sugarbaker system across 13 regions, assigning lesion size (LS) scores from 0 to 3. MDCT-derived PCI was compared with intraoperative PCI. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.
RESULTS: Peritoneal deposits were identified in 382 out of 897 regions (42.6%) during surgery. MDCT achieved 60.7% sensitivity and 91.3% specificity for differentiating LS 0-1 vs. 2-3, and 52.1% sensitivity and 87.4% specificity for LS 0 vs. 1-3. Overall accuracy was 84.1% and 72.4% for these respective thresholds. A strong correlation was observed between MDCT-PCI (7.3 ± 6.1) and intraoperative PCI (9.8 ± 6.9) (r = 0.83, p < 0.05). Optimal cytoreduction was achieved in 94% of patients.
CONCLUSION: MDCT reliably estimates peritoneal cancer index and guides surgical planning in HIPEC candidates with extensive disease, but its sensitivity for small or subcentimeter lesions, especially in the small bowel, remains limited, necessitating adjunctive imaging modalities.
KEY POINTS: Question Can contrast-enhanced multidetector CT accurately estimate the Sugarbaker peritoneal cancer index preoperatively to guide surgical selection in advanced ovarian cancer undergoing HIPEC? Findings Dual-threshold MDCT analysis demonstrated a strong correlation with intraoperative PCI (r = 0.83) and achieved 84.1% accuracy for identifying clinically significant peritoneal disease. Clinical relevance Preoperative MDCT-based PCI assessment supports surgical planning and prognostic stratification in advanced ovarian cancer considered for HIPEC. Although sensitivity is limited for small bowel lesions, MDCT provides clinically useful tumor burden estimation to guide treatment selection.
引用
- Liu JH, Wu YF, Lin Y, et al. Diagnostic accuracy of MDCT for preoperative peritoneal cancer index estimation in advanced ovarian cancer undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC): a Sugarbaker-based analysis. Eur Radiol. 2026. PMID: 41995741. doi:10.1007/s00330-026-12529-0
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。