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The Utility of Peritoneal Biopsy and Omentectomy in the Upstaging of Apparent Early Ovarian Cancer
  1. Rupal Shroff, MD,
  2. Rebecca A. Brooks, MD,
  3. Israel Zighelboim, MD,
  4. Matthew A. Powell, MD,
  5. Premal H. Thaker, MD,
  6. David G. Mutch, MD and
  7. L. Stewart Massad, MD
  1. Division of Gynecologic Oncology, Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO.
  1. Address correspondence and reprint requests to Rupal Shroff, MD, 1 Barnes-Jewish Hospital Plaza, St. Louis, MO 63110. E-mail: shroffr{at}wustl.edu.

Abstract

Hypothesis: The hypothesis of this study is that routine blind peritoneal biopsies performed during the surgical staging of apparent early ovarian cancers rarely influence final cancer stage and thus are of little benefit to staging. Few studies have been done examining this question of whether the biopsies of grossly normal-appearing peritoneal tissue are of benefit to the surgical staging procedure.

Methods: Operative and pathology reports from 122 patients with early-stage epithelial ovarian cancer staged by gynecologic oncologists at Barnes-Jewish Hospital from 1995 to 2009 were reviewed. All had full surgical staging resulting in a final stage of IA to IIIA. The operative findings were assessed to determine how frequently the peritoneal biopsies upstaged the cancer. Other findings including age, grade, histological type, and preoperative CA-125 were assessed.

Results: The median age of the patients was 53 years (range, 23-81 years). The distribution of cancer types was endometrioid (42), serous (23), clear cell (19), mucinous (16), and mixed or other (22). The most frequent stage was IC (n = 50; 41%), followed by IA (n = 40; 33%). A total of 19 patients had positive peritoneal biopsies (16%). Of these, only 6 (5%) were microscopically positive, or from normal-appearing tissue. Five (4%) of these 6 subjects were upstaged by the random peritoneal biopsies alone. Five (4%) of the patients had microscopic metastases to the omentum, 4 (3%) of whom were upstaged by this finding alone. One patient had both microscopic peritoneal and omental disease.

Conclusions: Although the rate of microscopic metastases to peritoneal tissue is low, random peritoneal biopsies are still indicated in early-stage disease owing to the low morbidity of the procedure and a small but present possibility of upstaging and altered management. Furthermore, systematic peritoneal biopsies ensure careful palpation and examination of all surfaces.

  • Ovarian cancer
  • Staging
  • Peritoneal biopsies

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Footnotes

  • The authors have no support or funding sources to disclose.

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