What is the Optimal Preoperative Imaging Modality for Assessing Peritoneal Cancer Index? An Analysis From the United States HIPEC Collaborative

Rachel M Lee; Mohammad Y Zaidi; Adriana C Gamboa; Shelby Speegle; Charles W Kimbrough; Jordan M Cloyd; Jennifer L Leiting; Travis E Grotz; Andrew J Lee; Keith F Fournier; Benjamin D Powers; Sean P Dineen; Joel Baumgartner; Jula Veerapong; Callisia N Clarke; Jeffrey J Sussman; Sameer Patel; Ryan J Hendrix; Laura A Lambert; Kara A Vande Walle; Daniel E Abbott; Christopher J LaRocca; Mustafa Raoof; Nadege Fackche; Fabian M Johnston; Charles A Staley; Shishir K Maithel; Maria C Russell

doi:10.1016/j.clcc.2019.12.002

What is the Optimal Preoperative Imaging Modality for Assessing Peritoneal Cancer Index? An Analysis From the United States HIPEC Collaborative

Clin Colorectal Cancer. 2020 Mar;19(1):e1-e7. doi: 10.1016/j.clcc.2019.12.002. Epub 2019 Dec 12.

Authors

Rachel M Lee¹, Mohammad Y Zaidi¹, Adriana C Gamboa¹, Shelby Speegle¹, Charles W Kimbrough², Jordan M Cloyd², Jennifer L Leiting³, Travis E Grotz³, Andrew J Lee⁴, Keith F Fournier⁴, Benjamin D Powers⁵, Sean P Dineen⁵, Joel Baumgartner⁶, Jula Veerapong⁶, Callisia N Clarke⁷, Jeffrey J Sussman⁸, Sameer Patel⁸, Ryan J Hendrix⁹, Laura A Lambert¹⁰, Kara A Vande Walle¹¹, Daniel E Abbott¹¹, Christopher J LaRocca¹², Mustafa Raoof¹², Nadege Fackche¹³, Fabian M Johnston¹³, Charles A Staley¹, Shishir K Maithel¹, Maria C Russell¹⁴

Affiliations

¹ Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA.
² Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
³ Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN.
⁴ Division of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
⁵ Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL.
⁶ Division of Surgical Oncology, Department of Surgery, University of California San Diego, San Diego, CA.
⁷ Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
⁸ Department of Surgery, University of Cincinnati, Cincinnati, OH.
⁹ Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA.
¹⁰ Huntsman Cancer Institute, Division of Surgical Oncology, Department of Surgery, University of Utah, Salt Lake City, UT.
¹¹ Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI.
¹² Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA.
¹³ Department of Surgery, Johns Hopkins University, Baltimore, MD.
¹⁴ Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA. Electronic address: maria.c.russell@emory.edu.

PMID: 31974019
DOI: 10.1016/j.clcc.2019.12.002

Abstract

Background: Radiographic prediction of peritoneal carcinomatosis index (PCI) can improve patient selection for cytoreductive surgery. We aimed to determine the correlation of computed tomography (CT)-predicted PCI (CT-PCI) and magnetic resonance imaging (MRI)-predicted PCI (MRI-PCI) with intraoperative-PCI, and if a preoperative-PCI cutoff is associated with incomplete cytoreduction.

Patients and methods: Patients from the US HIPEC Collaborative (2000-2017) with appendiceal, colorectal, or peritoneal mesothelioma (PM) histology who underwent cytoreductive surgery were included. Pearson correlation coefficients were used to determine correlation between preoperative and intraoperative-PCI values. Fisher r-to-z transformation was used to compare correlations.

Results: A total of 488 patients were included. Of these, 34% had noninvasive appendiceal, 30% invasive appendiceal, 28% colorectal, and 8% PM histology. CT-PCI was correlated with intraoperative-PCI for patients with noninvasive and invasive appendiceal and colorectal histologies (r = 0.689, 0.554, and 0.571; all P < .001), but not PM (r = 0.188; P = .295). MRI-PCI was correlated with intraoperative-PCI for all histologies (non-invasive appendiceal: r = 0.591; P = .002; invasive appendiceal: r = 0.848; P < .001; colorectal: r = 0.729; P < .001; PM: r = 0.890; P = .007). Comparing CT and MRI, correlations were similar in noninvasive appendiceal and colorectal histologies; MRI was better for invasive appendiceal and PM (P = .005 and P = .021, respectively). Twenty-eight (6%) patients underwent an incomplete cytoreduction (cytoreduction score, 2-3). PCI greater than 15 was associated with cytoreduction score of 2 to 3 for both CT and MRI (CT-PCI: odds ratio, 3.0; P = .033; MRI-PCI: odds ratio, 7.6; P = .071).

Conclusions: In this multi-institutional cohort, CT and MRI-PCI correlate well with intraoperative-PCI. MRI appears to be superior for invasive appendiceal and peritoneal mesothelioma. External validation in a larger population is needed.

Keywords: CRS/HIPEC; Invasive appendiceal carcinoma; Noninvasive appendiceal carcinoma; Peritoneal mesothelioma; Radiographic PCI.

Publication types

Comparative Study
Evaluation Study
Multicenter Study

MeSH terms

Adult
Aged
Appendiceal Neoplasms / diagnostic imaging*
Appendiceal Neoplasms / pathology
Appendiceal Neoplasms / surgery
Colorectal Neoplasms / diagnostic imaging*
Colorectal Neoplasms / pathology
Colorectal Neoplasms / surgery
Cytoreduction Surgical Procedures
Diffusion Magnetic Resonance Imaging / statistics & numerical data
Female
Humans
Male
Mesothelioma / diagnostic imaging*
Mesothelioma / pathology
Mesothelioma / surgery
Middle Aged
Patient Selection
Peritoneal Neoplasms / diagnosis*
Predictive Value of Tests
Preoperative Care / methods*
Preoperative Care / statistics & numerical data
Retrospective Studies
Tomography, X-Ray Computed / statistics & numerical data
United States