Comparison of Peritoneal Carcinomatosis Scoring Methods to Assess Resectability in Ovarian Carcinoma

Objective Comparison of peritoneal carcinomatosis scoring methods in carcinoma of the ovary and evaluation of their prediction of complete cytoreduction in patients with stage III epithelial ovarian cancer. Methods This prospective observational study included 100 patients with stage III epithelial ovarian cancer treated at a tertiary cancer center from July 2020 to October 2021. Preoperative assessment involved USG and contrast-enhanced CT (CECT) to calculate the Peritoneal Carcinomatosis Index (PCI). Diagnostic laparoscopy was performed to record the Fagotti score. Intraoperatively, surgical PCI was determined, followed by cytoreductive surgery. Correlation between imaging-derived and surgical PCI scores was analyzed using Spearman's correlation. Receiver operating characteristic (ROC) analysis was performed to identify PCI cutoff values predictive of complete cytoreduction. Results The mean surgical PCI was 8.05, while the mean CT-PCI and USG-PCI were 5.63 and 4.21, respectively. CT-PCI showed a stronger correlation with surgical PCI (ρ = 0.867) than USG-PCI (ρ = 0.750), both statistically significant (p < 0.001). The majority of patients (73%) had a Fagotti score of 0, and none scored ≥8. Complete cytoreduction was achieved in 98% of cases. A surgical PCI cutoff of 14.5 predicted complete cytoreduction with 84.7% sensitivity and 100% specificity. CT demonstrated higher accuracy than USG in detecting disease across abdominal regions, especially outside the pelvis; both were limited in identifying small bowel involvement. Conclusions CT-based PCI is the most reliable noninvasive modality for preoperative assessment of peritoneal disease burden. In select post-neoadjuvant patients with favorable imaging, laparoscopy may be omitted, optimizing surgical planning and outcomes.