A CT that describes where the disease is in the sites that make complete cytoreduction difficult: the root of the small bowel mesentery, porta hepatis, lesser sac, diaphragm, and supradiaphragmatic nodes — not only "peritoneal disease present".
Orient first
- Most present with FIGO stage III (peritoneal disease beyond the pelvis — verify the edition).
- Surgeons want to know about disease in sites that predict suboptimal debulking; neoadjuvant chemotherapy may be chosen instead.
- Cardiophrenic and supraclavicular nodes and pleural disease make it stage IV.
Acquire the study
- Portal venous phase CT of chest, abdomen and pelvis, thin reconstructions with coronal and sagittal reformats; oral water or positive contrast to separate bowel.
The manoeuvre
- Adnexal masses: size in cm, solid components, bilaterality.
- Peritoneum: omentum, right subphrenic space, liver and spleen surface, pouch of Douglas — size of largest deposit.
- Difficult sites: small bowel mesentery root, porta hepatis, lesser sac, gastrosplenic ligament, splenic hilum.
- Nodes: pelvic, para-aortic up to the renal veins, cardiophrenic (> 5 mm short axis — verify), supraclavicular.
- Chest: pleural effusion and nodules; parenchymal liver or spleen metastases (stage IV) vs surface deposits.
What confirms it
- Adnexal mass with peritoneal disease and histology; the stage stated by edition.
What licenses you to exclude it
- CT cannot exclude small-volume peritoneal disease; laparoscopy is the reference for resectability.
The classic misread
- Calling surface splenic or hepatic implants parenchymal metastases (which changes stage IIIC to IVB).