Diffusion-weighted magnetic resonance imaging for the pre-operative evaluation of epithelial ovarian cancer patients

Objective To investigate the value diffusion-weighted magnetic resonance imaging (DWI/MR) in the selection of ovarian cancer patients suitable for primary debulking surgery. Methods Patients with suspected ovarian cancer who underwent pre-operative DWI/MR were enrolled between April 2020 and March 2022. All participants received preoperative clinic-radiological assessment according to the Suidan criteria for R0 resection with a predictive score. Data for patients with primary debulking surgery were prospectively recorded. The diagnostic value was calculated with ROC curves, and the cut-off value for the predictive score was also explored. Results 80 patients with primary debulking surgery were included in the final analysis. The majority (97.5%) of patients were at advanced stage (III-IV), and 90.0% of patients had high-grade serous ovarian histology. 46 (57.5%) patients had no residual disease (R0), and 27 (33.8%) patients had optimal debulking surgery with zzmacroscopic disease less than or equal to 1 cm (R1). Patients with BRCA1 mutation had lower R0 resection rate, higher R1 resection rate compared with wild-type patients (42.9% vs 63.0%, 50.0% vs 29.6%, respectively). The median (range) predictive score was 4 (0−13), and the AUC for R0 resection was 0.742 (0.632–0.853). The R0 rates for patients with predictive score 0–2, 3–5, and ≥ 6 were 77.8%, 62.5% and 23.8%, respectively. Conclusion DWI/MR was a sufficient technique for pre-operative evaluation of ovarian cancer. Patients with predictive score 0–5 were suitable for primary debulking surgery at our institution.