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The following is a summary of “What is the accuracy, sensitivity and specificity of the radiological peritoneal cancer index in repeat cytoreductive surgery: a retrospective study,” published in the April 2025 issue of the World Journal of Surgical Oncology by Garrett et al.

Repeat cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (rCRS-HIPEC) has emerged as a viable treatment strategy that offers prolonged survival for selected patients with peritoneal surface malignancies. Patient selection remains a critical determinant of treatment success, with the extent and distribution of recurrent peritoneal disease serving as key factors. Radiological assessment using the peritoneal cancer index (PCI) plays a central role in preoperative planning; however, its reliability across imaging modalities remains to be fully established. This study aimed to assess the accuracy, sensitivity, and specificity of radiological PCI—derived from computed tomography (CT) and fluorodeoxyglucose positron emission tomography (FDG-PET)—in predicting intraoperative PCI in patients undergoing rCRS-HIPEC.

A retrospective analysis was conducted on patients who underwent rCRS-HIPEC for recurrent peritoneal malignancies between January 2022 and December 2023. Radiological PCI values, calculated from preoperative imaging (CT and/or FDG-PET), were compared to surgical PCI determined intraoperatively. The study evaluated the overall and regional accuracy, sensitivity, and specificity of radiological PCI, stratified by imaging modality and abdominal region.

The study cohort included 32 patients. The overall accuracy, sensitivity, and specificity of radiological PCI in predicting surgical PCI were 63.0%, 30.8%, and 79.9%, respectively. When comparing imaging modalities, FDG-PET demonstrated slightly higher accuracy (67.5% vs. 62.6%) and specificity (84.8% vs. 75.8%) than CT. However, both modalities exhibited low overall sensitivity (FDG-PET: 33.3%, CT: 34.9%), indicating limited capability to detect the full extent of disease preoperatively.

Regional analysis revealed variable diagnostic performance across different anatomical sites. Both FDG-PET and CT showed high sensitivity for detecting pelvic disease (80% and 87.5%, respectively), indicating strong utility in this region. Conversely, sensitivity was markedly lower in the small bowel (25–33.3%) and epigastric regions (FDG-PET: 25%, CT: 0%), reflecting ongoing challenges in imaging these areas. Importantly, for each abdominal region, no statistically significant differences were observed between imaging modalities in terms of the discrepancy between radiological and surgical PCI.

Radiological PCI demonstrates high specificity in assessing peritoneal recurrence, supporting its use as a valuable tool in guiding perioperative strategy for rCRS-HIPEC. FDG-PET appears to offer superior specificity and accuracy compared to CT, although both modalities remain limited in sensitivity, particularly in certain abdominal regions. Continued refinement in imaging techniques and multimodal approaches is warranted to enhance preoperative assessment and optimize surgical outcomes.

Source: wjso.biomedcentral.com/articles/10.1186/s12957-025-03775-5