Comparative study between computed tomography and surgical staging of ovarian cancer among patients attending Muhimbili national hospital

Abstract

ABSTRACT Background: Ovarian cancer is a significant cause of mortality among gynecologic malignancies worldwide, resulting in over 200,000 deaths annually. However, in Tanzania, the understanding of the CT scan finding and their significance on the ovarian tumour staging is limited and is not used frequently. The comparison between radiological and surgical staging of ovarian cancer is crucial for guiding treatment decisions and improving patient outcomes. Aim: The study aim was to assess the comparison between radiological (CT scan) and surgical staging of ovarian cancer among women attending Muhimbili National Hospital (MNH). Methods: This was a cross-sectional, retrospective hospital-based study that utilized medical records from 43 participants who attended Muhimbili National Hospital (MNH) between January 2022 and January 2024. Data collection was conducted using Open Data Kit (ODK), which implemented a pre-developed checklist to gather information on demographics, clinical presentation, surgical findings, and CT scan results. The collected data was organized in MS Excel and analysed using SPSS version 27. Descriptive statistics were employed to summarize the data at a univariate level, using frequency distribution. Relationships between independent and dependent variables were assessed via cross-tabulation and Chi-Square tests, with statistical significance determined at a p-value of less than 0.05. Results: This study involved 43 ovarian cancer patients with a median age of 54 years. All participants presented with abdominal pain or swelling (100%), followed by abdominal fullness in 38 patients (88.4%) and back pain in 5 patients (11.6%). Explorative laparotomy was performed in all patients, revealing ovarian mass/masses in every case. Additionally, ascites was identified in 36 patients (83.7%), and omental caking was xiii observed in 25 patients (58.1%). These findings were mirrored by CT scans, with ascites present in 30 patients (69.8%) and omental caking in 24 patients (55.8%). CT scans showed a sensitivity, specificity, and accuracy of 100% for stage I, 100%, 97.2%, and 97.7% for stage II, and 80.6%, 100%, and 86.1% for stage III, respectively. The overall CT scan sensitivity and PPV was 97.4% and 81.1% respectively. The pre-surgical CT staging was highly significant (p-value < 0.001), underscoring its crucial role in aiding surgeons to plan treatments, particularly for ovarian cancer patients before laparotomy. Conclusion: There is a significant association (p value <0.000) between CT scan and surgical staging that highlights the potential of CT imaging as a preoperative staging tool for ovarian cancer. Recommendation: In every patient with suspected ovarian cancer, a staging CT scan should be performed prior to intervention. Further research is recommended, with a bigger sample size focusing on the diagnostic power of CT scans with reference to the specific local and distant extensions of ovarian cancer disease.