J Gynecol Oncol.  2011 Dec;22(4):260-268. 10.3802/jgo.2011.22.4.260.

Thoracic metastasis in advanced ovarian cancer: comparison between computed tomography and video-assisted thoracic surgery

• Mironov O
• Sala E
• Mironov S
• Pannu H
• Chi DS
• Hricak H

• KMID: 2173628
• DOI: http://doi.org/10.3802/jgo.2011.22.4.260

Abstract

OBJECTIVE
To determine which computed tomography (CT) imaging features predict pleural malignancy in patients with advanced epithelial ovarian carcinoma (EOC) using video-assisted thoracic surgery (VATS), pathology, and cytology findings as the reference standard.
METHODS
This retrospective study included 44 patients with International Federation of Obstetrics and Gynecology (FIGO) stage III or IV primary or recurrent EOC who had chest CT < or =30 days before VATS. Two radiologists independently reviewed the CT studies and recorded the presence and size of pleural effusions and of ascites; pleural nodules, thickening, enhancement, subdiaphragmatic tumour deposits and supradiaphragmatic, mediastinal, hilar, and retroperitoneal adenopathy; and peritoneal seeding. VATS, pathology, and cytology findings constituted the reference standard.
RESULTS
In 26/44 (59%) patients, pleural biopsies were malignant. Only the size of left-sided pleural effusion (reader 1: rho=-0.39, p=0.01; reader 2: rho=-0.37, p=0.01) and presence of ascites (reader 1: rho=-0.33, p=0.03; reader 2: rho=-0.35, p=0.03) were significantly associated with solid pleural metastasis. Pleural fluid cytology was malignant in 26/35 (74%) patients. Only the presence (p=0.03 for both readers) and size (reader 1: rho=0.34, p=0.04; reader 2: rho=0.33, p=0.06) of right-sided pleural effusion were associated with malignant pleural effusion. Interobserver agreement was substantial (kappa=0.78) for effusion size and moderate (kappa=0.46) for presence of solid pleural disease. No other CT features were associated with malignancy at biopsy or cytology.
CONCLUSION
In patients with advanced EOC, ascites and left-sided pleural effusion size were associated with solid pleural metastasis, while the presence and size of right-sided effusion were associated with malignant pleural effusion. No other CT features evaluated were associated with pleural malignancy.

Keyword

Computed tomography; Malignant/diagnosis; Ovarian neoplasms; Pleural effusion; Pleural neoplasms; Thoracic surgery/video-assisted

MeSH Terms

Ascites
Biopsy
Gynecology
Humans
Neoplasm Metastasis
Obstetrics
Ovarian Neoplasms
Pleural Diseases
Pleural Effusion
Pleural Effusion, Malignant
Pleural Neoplasms
Retrospective Studies
Seeds
Thoracic Surgery, Video-Assisted
Thorax

Figure

• 

  Fig. 1 Postmenopausal female with stage IV high-grade papillary serous carcinoma. (A) Contrast-enhanced computed tomography (CT) scan demonstrates bilateral pleural effusions (white arrows), larger on the right side, at the time of initial diagnosis. Right-sided pleural tap revealed positive cytology. Subsequently, bilateral video-assisted thoracic surgery was performed and revealed the presence of microscopic pleural metastasis bilaterally. Pleural effusions were treated with talc pleurodesis. (B) Post-treatment follow-up CT images demonstrate residual loculated small bilateral effusions (black arrow) and talc-related hyperdensity within the right pleural space (white arrow). (C) Contrast-enhanced CT scan 4 months after initial diagnosis and neoadjuvant chemotherapy showing residual disease in the abdomen and pelvis (white arrow) that was subsequently treated with optimal debulking. (D) Contrast-enhanced CT scan 6 months after optimal debulking showing gross pleural metastases (white arrows).

• 

  Fig. 2 Photographs obtained during video-assisted thoracic surgery show (A) white tumor plaques (white arrow) and collapsed lung (black arrow), (B) tumor plaques on the pleura (arrow), and (C) biopsy of pleural tumor.

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