CHENNAI: “Standardising how we read CT scans can change treatment decisions on the ground,” clinicians at Christian Medical College (CMC), Vellore, have said, as a prospective study published in The Lancet Regional Health – Southeast Asia recently, sets out a structured approach to managing advanced ovarian cancer.
The study, conducted between September 2022 and February 2024, analysed 124 patients with stage III and IV epithelial ovarian cancer and reviewed 175 contrast-enhanced CT scans using a reporting framework known as the CT PAUSE score.
The system brings uniformity to imaging by assessing tumour spread, ascites, involvement of key anatomical sites, bowel disease and distant metastases, allowing multi-disciplinary teams to take clearer, more consistent calls on treatment. The results underline its clinical value.
Among patients selected for surgery using the PAUSE-guided approach, 89.3% achieved complete cyto-reduction, widely regarded as the most important factor influencing survival in advanced ovarian cancer. “Accurate pre-operative imaging is central to treatment planning. A structured tool helps align radiology findings with surgical decision-making,” the authors said.
Accurate pre-operative imaging is central to treatment planning. A structured tool helps align radiology findings with surgical decision-making- Authors of the study
A structured CT-based approach that improves accuracy without adding cost or complexity could help streamline care and improve outcomes
Ovarian cancer continues to be detected late in a majority of cases, often after it has spread across the abdominal cavity. In such scenarios, deciding whether to operate upfront or begin with chemotherapy is critical and often hinges on how precisely disease extent is assessed.
At CMC Vellore, the PAUSE framework was integrated into routine tumour board deliberations involving oncologists, surgeons, radiologists and pathologists. Patients with limited disease burden were taken up for primary surgery, while those with extensive spread, particularly involving the small bowel or difficult-to-resect regions, were directed towards chemotherapy before surgery was considered.
The study also evaluated a simplified model focusing on upper abdominal disease burden, which showed better predictive accuracy than the full scoring system. Researchers said this approach could be more practical in high-volume centres where rapid, reliable decisions are needed.
Clinicians said the framework reduces variation in CT reporting and improves agreement between imaging findings and surgical feasibility. “It brings clarity at the decision-making stage and helps avoid both unnecessary surgery and missed opportunities for timely intervention,” the study said.
The findings carry particular relevance for Tamil Nadu and similar settings, where tertiary hospitals handle large caseloads and CT remains the primary imaging tool. A structured CT-based approach that improves accuracy without adding cost or complexity could help streamline care and improve outcomes.
While the authors note that the findings are based on a single-centre study and require validation across institutions, they point to a practical shift towards more standardised cancer care.
With most ovarian cancer patients presenting late, clinicians say clearer imaging assessment could play a decisive role in ensuring that the right patients are taken up for surgery at the right time, a step that could directly influence survival.