Thoracic metastasis in advanced ovarian cancer: comparison between computed tomography and video-assisted thoracic surgery.
10.3802/jgo.2011.22.4.260
- Author:
Oleg MIRONOV
1
;
Evis SALA
;
Svetlana MIRONOV
;
Harpreet PANNU
;
Dennis S CHI
;
Hedvig HRICAK
Author Information
1. Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, USA. hricakh@mskcc.org
- Publication Type:Original Article
- Keywords:
Computed tomography;
Malignant/diagnosis;
Ovarian neoplasms;
Pleural effusion;
Pleural neoplasms;
Thoracic surgery/video-assisted
- MeSH:
Ascites;
Biopsy;
Gynecology;
Humans;
Neoplasm Metastasis;
Obstetrics;
Ovarian Neoplasms;
Pleural Diseases;
Pleural Effusion;
Pleural Effusion, Malignant;
Pleural Neoplasms;
Retrospective Studies;
Seeds;
Thoracic Surgery, Video-Assisted;
Thorax
- From:Journal of Gynecologic Oncology
2011;22(4):260-268
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To determine which computed tomography (CT) imaging features predict pleural malignancy in patients with advanced epithelial ovarian carcinoma (EOC) using video-assisted thoracic surgery (VATS), pathology, and cytology findings as the reference standard. METHODS: This retrospective study included 44 patients with International Federation of Obstetrics and Gynecology (FIGO) stage III or IV primary or recurrent EOC who had chest CT < or =30 days before VATS. Two radiologists independently reviewed the CT studies and recorded the presence and size of pleural effusions and of ascites; pleural nodules, thickening, enhancement, subdiaphragmatic tumour deposits and supradiaphragmatic, mediastinal, hilar, and retroperitoneal adenopathy; and peritoneal seeding. VATS, pathology, and cytology findings constituted the reference standard. RESULTS: In 26/44 (59%) patients, pleural biopsies were malignant. Only the size of left-sided pleural effusion (reader 1: rho=-0.39, p=0.01; reader 2: rho=-0.37, p=0.01) and presence of ascites (reader 1: rho=-0.33, p=0.03; reader 2: rho=-0.35, p=0.03) were significantly associated with solid pleural metastasis. Pleural fluid cytology was malignant in 26/35 (74%) patients. Only the presence (p=0.03 for both readers) and size (reader 1: rho=0.34, p=0.04; reader 2: rho=0.33, p=0.06) of right-sided pleural effusion were associated with malignant pleural effusion. Interobserver agreement was substantial (kappa=0.78) for effusion size and moderate (kappa=0.46) for presence of solid pleural disease. No other CT features were associated with malignancy at biopsy or cytology. CONCLUSION: In patients with advanced EOC, ascites and left-sided pleural effusion size were associated with solid pleural metastasis, while the presence and size of right-sided effusion were associated with malignant pleural effusion. No other CT features evaluated were associated with pleural malignancy.
