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Peritoneal Cancer Index Correlates with Radiographic Assessment of Colorectal Carcinomatosis
Eleanor A Fallon1, Muhammad O Awiwi2, Neal Bhutiani3
1Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Annals of Surgical Oncology
|December 28, 2024
Summary
Radiologists and surgeons show good agreement in assessing the radiologic Peritoneal Cancer Index (rPCI), a reproducible method for evaluating peritoneal carcinomatosis burden. This imaging tool can help rule out patients for cytoreductive surgery (CRS).
Area of Science:
- Oncology
- Radiology
- Surgical Oncology
Background:
- The Peritoneal Cancer Index (PCI) is crucial for intraoperative assessment of peritoneal carcinomatosis.
- Previous correlations between computed tomography (CT) and intraoperative PCI have shown inconsistent results.
- This study addresses the variability in radiologic PCI (rPCI) assessment between radiologists and surgeons.
Purpose of the Study:
- To quantify the variation in radiologic Peritoneal Cancer Index (rPCI) assessment between radiologists and surgeons.
- To evaluate the interobserver reproducibility of rPCI in patients with peritoneal carcinomatosis.
- To compare preoperative rPCI with intraoperative PCI to assess its utility in patient selection for cytoreductive surgery (CRS).
Main Methods:
- Radiologic PCI (rPCI) was calculated by an abdominal radiologist and a surgeon for 104 patients with peritoneal carcinomatosis.
- A separate cohort of 36 patients was analyzed to compare preoperative rPCI with intraoperative PCI.
- Agreement between assessments was quantified using kappa statistics and other statistical tests.
Main Results:
- The median rPCI was 12 (IQR, 6-23) by radiologists and 9 (IQR, 6-15) by surgeons in the 104-patient cohort.
- Good agreement was observed for rPCI cutoffs of 15 (kappa, 0.40) and 20 (kappa, 0.24).
- In the 36-patient cohort, median rPCI (4) was significantly lower than median intraoperative PCI (11) (p < 0.001).
Conclusions:
- Radiologic PCI (rPCI) demonstrates good interobserver reproducibility between surgeons and radiologists, particularly at higher cutoffs (>15 and >20).
- rPCI consistently underestimates intraoperative PCI, suggesting its utility as a conservative tool for assessing peritoneal disease burden.
- rPCI may aid in ruling out patients as candidates for cytoreductive surgery (CRS) based on institutional cutoffs, complementing surgical exploration.
