Papel de la tomografía computarizada multidetector como herramienta de selección para cirugía de citorreducción y cirugía de citorreducción y quimioterapia intraperitoneal hipertérmica en la carcinomatosis peritoneal: concordancia entre el Índice de Carcinomatosis Peritoneal radiológico y quirúrgico

Objective

To evaluate the accuracy of multidetector computed tomography (MDCT) to select patients with peritoneal carcinomatosis (PC) as candidates for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC), through an analysis of the degree of correlation between the radiological (rPCI) and surgical (sPCI) scores in the PC index.

Methods

Observational, retrospective, single-centre study between 1 May 2014 and 31 May 2018. Calculated rPCI assessed by MDCT was compared with the sPCI using the Concordance Correlation Coefficient (CCC). The Bland-Altman method was used to plot the difference between the two observations against their mean with a confidence interval (CI) of 95%. We assessed whether tumour volume affects the CCC by setting a cut-off point of sPCI at 15 and considering a sensitivity and specificity of rPCI > 20 as a predictor of unresectability.

Results

50 patients underwent surgery. Mean sPCI was 11.8 (9.5) and rPCI was 11.0 (10.2), with a CCC of 0.94 (95% CI: 0.91–0.97). The CCC in the 35 patients with sPCI 20 had a sensitivity of 0.82 (95% CI: 0.68–0.92) and a specificity of 0.40 (95% CI: 0.05–0.85). The positive predictive value was 0.92 (95% CI: 0.80–0.98), while the negative predictive value was 0.20 (95% CI: 0.03–0.56).

Conclusion

MDCT, interpreted by an expert radiologist, is reliable for the selection of patients as candidates for CRS + HIPEC; however, the rPCI value cannot be considered in isolation as a contraindication to full treatment. Greater tumour volume usually leads to a worse concordance between rPCI and sPCI.