Alessi 2016.

Study characteristics
Patient sampling	Aim of the study: to investigate the role of PET(‐CT) in characterisation of ovarian masses and identification of critical areas of tumour spread affecting results of debulking surgery Type of study: prospective study Enrolled/eligible: 29/23 Inclusion period: 2013 to 2014
Patient characteristics and setting	Inclusion criteria: elevated serum CA125 and ultrasound detection of suspected ovarian malignancies Exclusion criteria: blood glucose levels > 140 mg/dL Mean age (range): 62 years (21 to 82) Setting: Gynaecologic Oncology Unit, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy
Index tests	Whole body FDG‐PET/CT Criteria to consider primary debulking unfeasible: involvement of porta hepatis, diffuse deep infiltration of root mesentery, diffuse carcinomatosis requiring complete colectomy or more than 4 bowel resections or total gastrectomy, deep infiltration of pancreas and duodenum, multiple liver metastases
Target condition and reference standard(s)	Target condition: debulking with no macroscopically visible tumour remaining after surgery Reference standard: all patients underwent explorative laparotomy and, where surgery was considered feasible, patients had primary debulking
Flow and timing	PET/CT was performed within 20 days of surgery. All patients received debulking surgery. 23 out of 29 patients were diagnosed with ovarian cancer and were eligible for analysis.
Comparative
Notes	Four patients had stage IC disease, 14 stage IIIC and three stage IV so it seems that two patients were missing in the stage description (n = 23).
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Yes
Did the study avoid inappropriate exclusions?	Yes
Were the patients diagnosed by conventional diagnostic work‐up for advanced stage cancer?	Yes
Were the patients planned for primary debulking surgery after conventional diagnostic work‐up?	Yes
		Low	Low
DOMAIN 2: Index Test PET/CT
Were the index test results interpreted without knowledge of the results of the reference standard?	Yes
If a threshold was used, was it pre‐specified?	Yes
Did the whole sample, or a random selection of the sample, receive verification using a reference standard of diagnosis?	Yes
Did patients receive the same reference standard regardless of the index test result?	Yes
Were the same clinical data available when test results were interpreted as would be available when the test is used in clinical practice?	Yes
Did the study provide a clear definition of what was considered to be a ’positive’ result for the index test?	Yes
		Low	Low
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Yes
Were the reference standard results interpreted without knowledge of the results of the index tests?	Unclear
Is the surgeon's expertise adequate to perform the reference standard?	Unclear
Did the study provide a clear definition of what was considered to be a ’positive’ result for the reference standard?	Yes
		Unclear	Low
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Yes
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	Yes
Were withdrawals from the study reported?	Yes
		Low