Correlation of abdominal computed tomography scanning and second-look operation findings in ovarian cancer patients

Abdominal computed tomography scanning (CT scan) was performed in 35 patients with ovarian carcinoma prior to undergoing a second-look operation. All patients were in complete clinical remission following 6 courses of chemotherapy. Results of the CT scans were compared and correlated with surgicopathological findings at second look. There were 9 true-positive, 12 true-negative, 2 false-positive, and 12 false-negative CT scan results. The sensitivity was 0.42, the specificity 0.85, diagnostic accuracy 0.6, positive predictive value 0.81, and the negative predictive value 0.50. Sensitivity was poor for omental, mesenteric, and peritoneal disease, better for metastases in lymph nodes, good for abdominal masses, and very good for ascites and disease in the liver. False-positive CT scan findings were due to either anatomic variations or adhesions and scarring resulting from postoperative changes. Four false-negative studies resulted from microscopic disease found at second look. In the remaining 8 false-negative studies, nodules or plaques more than 2 cm in diameter were not detected in the omentum (4 patients), in the mesentery and peritoneum (2 patients), and in the lymph nodes (2 patients). Due to a high false-negative rate, a normal CT scan cannot replace a second-look operation for accurate assessment of disease status.