Photo Credit: ALIOUI Mohammed Elamine

The following is a summary of “Prediction of nonresectability using the updated Predictive Index value model assessed by imaging and surgery in tubo-ovarian cancer: a prospective multicenter ISAAC study,” published in the December 2024 issue of Obstetrics and Gynecology by Moro et al.     

The Predictive Index Value (PIV) scoring system, developed by Fagotti et al., evaluates disease spread during surgery to help determine surgical outcomes for individuals with tubo-ovarian cancer.  

Researchers conducted a prospective study to compare ultrasound (US), contrast-enhanced computed tomography (CT), and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) in predicting nonresectable tumors using the updated PIV model.  

They involved 242 European individuals with suspected tubo-ovarian cancer (2018 to 2022). All participants underwent mandatory US and CT imaging, with optional WB-DWI/MRI. The updated PIV model determined nonresectability by identifying mesenteric retraction, miliary carcinomatosis, or PIV >8. Surgical outcomes (residual disease > 1 cm) were used as the reference standard. Area under the receiver operating characteristic curve (AUC) and Cohen’s kappa were calculated to assess the performance and agreement of each imaging method.  

The results showed 145 of 242 individuals (59.9%) achieved no residual tumor after surgery (R0), 17 (7.0%) had residual tumors of 1 cm or smaller (R1), and 80 (33.1%) had residual tumors > 1 cm (R2). The AUC for predicting nonresectability was 0.80 for US, 0.76 for CT, 0.71 for WB-DWI/MRI, and 0.90 for surgical exploration. The US demonstrated the highest agreement with intraoperative findings, with Cohen’s kappa values ranging from 0.59 to 0.79.  

They concluded that the US was noninferior to CT and WB-DWI/MRI in predicting tumor nonresectability and aligned well with intraoperative findings, supporting the use of trained professionals.  

Source: ajog.org/article/S0002-9378(24)00740-3/abstract