Espada 2013.

Study characteristics
Patient sampling	Aim of the study: to analyse the diagnostic accuracy of diffusion‐weighted MRI for predicting suboptimal cytoreductive surgery Type of study: prospective study Enrolled/eligible: 36/34 Inclusion period: 2006 to 2012
Patient characteristics and setting	Inclusion criteria: patients undergoing surgery for suspected ovarian carcinoma Exclusion criteria: none Mean age (SD): 53 years (11) Setting: Gynaecology Department, Hospital Universitario Quiron, Madrid, Spain
Index tests	Pelvic and abdominal diffusion‐weighted MRI Criteria to consider primary debulking unfeasible: involvement of stomach, lesser sac, liver, small bowel mesentery, splenic hilium, para‐aortic lymph nodes above level of renal vessels
Target condition and reference standard(s)	Target condition: optimal debulking with residual disease of maximal 1 cm in diameter Reference standard: primary debulking surgery
Flow and timing	MRI was performed within 15 days of surgery. All patients received debulking surgery. 34 out of 36 patients had ovarian cancer and were eligible for analysis.
Comparative
Notes
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Unclear
Did the study avoid inappropriate exclusions?	Unclear
Were the patients diagnosed by conventional diagnostic work‐up for advanced stage cancer?	Unclear
Were the patients planned for primary debulking surgery after conventional diagnostic work‐up?	Yes
		Unclear	Unclear
DOMAIN 2: Index Test MRI
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?	No
Did the study provide a clear definition of what was considered to be a ’positive’ result for the index test?	Yes
		Low	High
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?	Yes
Is the surgeon's expertise adequate to perform the reference standard?	Yes
Did the study provide a clear definition of what was considered to be a ’positive’ result for the reference standard?	Yes
		Low	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