ArticlePloS one2026
Impact of pre-segmented regions on CT-based evaluation of the Peritoneal Cancer Index: A reader study.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
12 authors.
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Abstract
objectivesAccurate assessment of peritoneal tumour burden is crucial for treatment selection and prognosis. The Peritoneal Cancer Index (PCI), traditionally assessed by laparoscopy, is increasingly applied to imaging. This study investigates whether pre-segmented radiological PCI (rPCI) regions on CT improve interobserver variability, diagnostic accuracy, and user experience. MATERIALS AND
methodsThis prospective, comparative reader study included nine contrast-enhanced CT scans from patients with peritoneal metastases of ovarian, gastric, or colorectal origin. Radiologists, surgeons, and gynaecologists independently scored rPCI on two scans: one with and one without pre-segmented rPCI regions shown as colour overlays. Interobserver variability, mean absolute error compared with surgical PCI (sPCI), and reader confidence were compared between both conditions. User experience was evaluated through structured feedback.
resultsIn total, 82 clinicians from 19 countries participated in this study. Each CT was assessed 8-10 times with and without overlaid segmentations. Pre-segmented region overlays did not significantly improve interobserver variability (p = 0.123), PCI accuracy (mean absolute error, p = 0.374), or reader confidence (p = 0.593). However, with use of segmentations, rPCI values were closer to sPCI in 7 of 9 scans. In regions 9-12, the proportion of participants reporting moderate or high confidence increased from 48-53% without overlays to 59-63% with overlays. User feedback was positive, with 83% of participants reporting the tool as useful, 82% as easy to use, and 71% indicating they would use it in clinical practice.
conclusionPre-segmented region overlays for CT-based rPCI assessment were positively received by clinicians. Although no statistically significant improvements in interobserver variability or accuracy were observed, the findings of this exploratory study support further evaluation in larger studies to determine their clinical value.
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