CT prior to second-look operation in ovarian cancer

Second-look surgery is used in restaging patients with ovarian cancer to define sites of recurrence, plan therapy, and perform tumor debulking. We evaluated the role of CT in detecting residual or recurrent tumor in 55 patients in whom 64 abdominopelvic CT scans were obtained. Forty-eight patients underwent a second-look operation, and eight of these patients had an additional third-look operation. CT correctly identified 17 (85%) of 20 cases with residual or recurrent pelvic disease and three (75%) of four cases with bulky abdominal disease. CT failed to detect tumor in any of the five cases with minimal abdominopelvic disease and was able to detect carcinomatosis in only two (8%) of 24 cases. In four cases, CT detected pelvic disease not identified on clinical pelvic examination. On the 56 scans in 48 patients with surgical proof (280 surgical findings), CT had a sensitivity of 40% (22/55) and a specificity of 99% (224/225). In seven additional patients, second-look laparotomy was canceled because of CT findings of extensive, unresectable tumor. We conclude that CT provided valuable information regarding residual or recurrent tumor prior to second- and third-look surgery. In selective cases, CT findings obviated unnecessary surgery. However, the CT's lack of sensitivity in identifying minimal abdominopelvic disease and carcinomatosis precludes its use as a substitute for second-look surgery.