Forstner 1995.

Study characteristics
Patient sampling	Aim of the study: to evaluate ovarian cancer staging and tumour resectability with abdominal CT or MRI Type of study: prospective study Enrolled/eligible: 128 were enrolled of whom 82 underwent abdominal CT or MRI. 50/82 patients underwent MRI and were included in our analysis. Inclusion period: 1990 to 1994
Patient characteristics and setting	Inclusion criteria: patients suspected of ovarian cancer scheduled for surgical staging Exclusion criteria: after inclusion, patients with neoadjuvant chemotherapy, benign disease, other intra‐abdominal malignancies, or those who had undergone surgery more than one month after MRI were excluded from the statistical analysis (n = 46) Mean age (range): 52 years (17 to 82) Setting: Department of Gynecologic Oncology, University of California School of Medicine, San Francisco, America
Index tests	MRI and/or abdominal CT. Patients undergoing MRI (with or without abdominal CT) were included in our analysis. Criteria to consider primary debulking unfeasible: tumour larger than 2 cm at root of mesentery, porta hepatis, omentum of lesser sac, intersegmental fissure of the liver, gastrosplenic ligament, diaphragm, dome of liver, enlarged lymph nodes around coeliac axis, and presacral extraperitoneal disease
Target condition and reference standard(s)	Target condition: debulking with residual disease < 2 cm Reference standard: primary debulking surgery
Flow and timing	MRI was performed within four weeks of surgery. All patients received debulking surgery.
Comparative
Notes	Patient scheduling was based on a variety of factors, including scheduling availability, preference of referring physician, and contraindications to abdominal CT or MRI. Also, there was a change in study design. From the initial 128 recruited patients, 82 patients underwent surgery and imaging and formed the study population.
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?	No
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?	Unclear
		High	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?	Unclear
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
		Unclear	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?	Yes
Did the study provide a clear definition of what was considered to be a ’positive’ result for the reference standard?	Unclear
		Low	Unclear
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?	No
Were all patients included in the analysis?	No
Were withdrawals from the study reported?	Yes
		High