DWI-MRI helpful for pre-operative evaluation of patients with ovarian cancer

"Patients with predictive score 0–5 were suitable for primary debulking surgery at our institution," Zheng Feng, Fudan University Shanghai Cancer Center, Shanghai, China, and colleagues reported.

Primary debulking surgery is considered the standard surgical treatment strategy for patients with ovarian cancer. Still, neoadjuvant chemotherapy may also be considered for women regarded as poor surgical candidates. For cancer assessment, laparoscopic evaluation has "great diagnostic value", but the authors note that the patients may refuse this strategy due to increased costs and its invasive nature.

Previous studies indicate that DWI-MRI has high accuracy by providing high signal intensities of structures with water movement restriction and "almost no" signal from other anatomical structures. Past studies also suggest this modality has higher diagnostic accuracy than CT for ovarian cancer assessment.

Against the above background, the research team aimed to investigate the value of diffusion-weighted magnetic resonance imaging in selecting ovarian cancer patients suitable for primary debulking surgery.

For this purpose, the researchers enrolled patients with suspected ovarian cancer who underwent preoperative DWI/MR between 2020 and 2022. The participants received a preoperative clinic-radiological assessment based on the Suidan criteria for R0 resection with a predictive score. They prospectively recorded data for patients with primary debulking surgery. Calculation of diagnostic value was done with ROC curves, and they also explored the cut-off value for the predictive score.

The study revealed the following findings:

· The final analysis included 80 patients with primary debulking surgery.

· Most patients (97.5%) were at an advanced stage (III-IV), and 90.0% had high-grade serous ovarian histology.

· 57.5% of patients had no residual disease (R0), and 33.8% had optimal debulking surgery with macroscopic disease less than or equal to 1 cm (R1).

· Patients with BRCA1 mutation had a lower R0 resection rate and higher R1 resection rate than wild-type patients (42.9% versus 63.0%, 50.0% versus 29.6%, respectively).

· The median predictive score was 4, and the AUC for R0 resection was 0.742.

· The R0 rates for patients with predictive scores 0–2, 3–5, and ≥ 6 were 77.8%, 62.5% and 23.8%, respectively.

"DWI/MR was a sufficient technique for preoperative assessment of ovarian cancer," the researchers wrote. "Patients with predictive score 0–5 were eligible for primary debulking surgery at our institution."

They noted that multi-centre cooperation is still required to establish the general criteria. Still, they highlighted that this personalized approach using DWI-MRI and laparoscopic findings criteria could successfully triage ovarian patients into different treatment approaches with elevated radical resection rates.

Reference:

Feng Z, Fu Y, Li R, Li H, Lu J, Chen X, Ju X, Wu X, Wen H. Diffusion-weighted magnetic resonance imaging for the preoperative evaluation of epithelial ovarian cancer patients. Gynecol Oncol. 2023 May 17;174:142-147. doi: 10.1016/j.ygyno.2023.03.014. Epub ahead of print. PMID: 37207498.