Contribution of abdominal computed tomography (CT) in the management of gynecologic cancer: Correlated study of CT image and gross surgical pathology

Abstract Abdominal computed tomography (CT) was performed in 30 patients with gynecologic cancer prior to surgery. These patients included 14 with cervical carcinoma, 4 with endometrial adenocarcinoma, 9 with ovarian cancer, 2 with vulvar carcinoma, and 1 with uterine sarcoma. Besides careful assessment of the abdomen by a gynecologic oncologist during laparotomy, detailed measurements were taken after the removal of tissues whenever possible. Intravenous pyelogram and liver scan were routinely performed preoperatively. Abdominal CT scan was extremely exact in the localization of enlarged retroperitoneal lymph nodes. All metastatic nodes were CT detectable. One-half of CT-detected nodes were cancer involved. CT images failed to differentiate metastatic nodes from hyperplastic and fatty nodes. The densities of cancer-involved nodes measured by the Hounsfield unit fell into the same range as hyperplastic nodes. Measurements of nodes from CT images were consistently smaller than those of actual ones. In patients who had nodes with fatty surroundings, the CT measurements were closer to the actual size. Dimensions of the uterus were also measured. Because of the limited cuts of the CT scan, the longitudinal dimension was not as accurate as the transverse dimension. Extensive omental involvement from ovarian carcinoma was accurately demonstrated by abdominal CT scan. Even though CT scan could demonstrate most space-occupying lesions in the liver, its sensitivity was less than that of the liver scan. CT scan of the kidney was very precise in revealing hydronephrosis, hydroureter, nonfunctioning kidney, and renal cyst. We concluded that an abdominal CT scan was extremely valuable in the management of patients with gynecologic cancer in delineating abnormal retroperitoneal nodes, and the demonstration of omental metastasis and ureteral obstruction. The abdominal CT scan not only identifies retroperitoneal lymphadenopathy, but also replaces intravenous pyelogram and liver scan in metastatic workup.