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Ultrasonography findings and tumour quantification in patients with pseudomyxoma peritonei
1Department of Oncology, Radiology, and Clinical Immunology, Uppsala University, Uppsala, Sweden.
Abstract:
Pseudomyxoma peritonei (PMP) is a disease with various clinical presentations and the diagnostic value of ultrasonography (US) is under investigated. The purpose of this study was to identify the most common US finding in PMP and to investigate US sensitivity, specificity, positive and negative predictive value in quantifying tumour burden in different abdomino-pelvic regions in PMP patients. Between February 2006 and December 2008, 54 patients were treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) due to PMP. The results from preoperative US examination with and without intravenously administrated contrast (SonoVue) were compared to surgical findings. The mean US peritoneal cancer index (PCI) was 6 (range 0-25) and the surgical PCI was 18 (range 3-27) p<0.0001. The histo-pathological subtypes did not influence the US findings. Ascites, bowel loops adhesions and omental cake were mostly visualised correctly by US. The sensitivity of US in quantification of tumour nodules was 91.5% (range 74-100%) and specificity was 33.8% (range 18-55%). The positive predictive value of US examination in PMP was 22% (range 11-44%) and the negative predictive value was 93% (range 77-100%). US can detect the most common PMP findings (ascites and omental cake). The sensitivity of US to quantify PMP tumour burden in different abdominio-pelvic region was relatively high, however, this imaging tool had low specificity.
Insights
Ultrasonography (US) effectively detects common pseudomyxoma peritonei (PMP) findings like ascites and omental cake. While US shows high sensitivity for tumor burden, its specificity in quantifying PMP is limited.
Area of Science:
- Oncology
- Medical Imaging
- Abdominal Surgery
Background:
- Pseudomyxoma peritonei (PMP) presents diversely, with ultrasonography's (US) diagnostic utility requiring further investigation.
- Accurate staging of PMP is crucial for treatment planning, including cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
Purpose of the Study:
- To determine the most frequent US findings in PMP patients.
- To evaluate the sensitivity, specificity, and predictive values of US in assessing PMP tumor burden across abdominopelvic regions.
Main Methods:
- Prospective study comparing preoperative US (with and without contrast) to surgical findings in 54 PMP patients undergoing CRS and HIPEC.
- Analysis of US accuracy in identifying ascites, bowel adhesions, and omental cake, and quantification of tumor burden using the Peritoneal Cancer Index (PCI).
Main Results:
- US demonstrated high sensitivity (91.5%) for detecting tumor nodules but low specificity (33.8%) in quantifying PMP tumor burden.
- US accurately visualized common findings such as ascites and omental cake.
- The mean US-derived PCI (6) significantly underestimated the surgical PCI (18).
Conclusions:
- Ultrasonography is valuable for identifying characteristic PMP features like ascites and omental cake.
- While US offers high sensitivity in detecting PMP tumor presence, its low specificity limits its accuracy in precise tumor burden quantification.
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