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When Ovarian Cancer Is Not: Characterizing Nonovarian Cancer Pathology in a Laparoscopy-Based Triage System
  1. Robert L. Dood, MD, MSCE,
  2. Nicole D. Fleming, MD,
  3. Robert L. Coleman, MD,
  4. Shannon N. Westin, MD, MPH,
  5. Olivia D. Lara, MD,
  6. Christopher J. LaFargue, MD,
  7. Jinsong Liu, MD, PhD and
  8. Anil K. Sood, MD
  1. The Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX.
  1. Address correspondence and reprint requests to Anil K. Sood, MD, Department of Gynecologic Oncology and Reproductive Medicine, Unit 1362, 1515 Holcombe Blvd, Houston, TX 77030. E-mail: asood{at}


Objective Establishing an accurate histologic diagnosis is essential for determining the appropriate course of therapy for ovarian cancer. This study sought to investigate and describe nonovarian cancer pathologies discovered during the systematic laparoscopic workup of presumed advanced ovarian cancer.

Methods A retrospective cohort of patients with presumed advanced ovarian cancer (based on elevated CA125 and/or imaging) presenting to our center without confirmed pathologic diagnosis were identified and characterized. Patients without ovarian cancer on final pathology were described and compared with those with confirmed epithelial ovarian cancer using standard statistical methods.

Results Nonovarian cancer was found in 26 (7.1%) of 365 cases over 3.5 years of study, and included benign ovarian pathology, and metastatic uterine, breast, and gastrointestinal cancers. Most nonovarian cancer cases could not be diagnosed with percutaneous biopsy, and instead used diagnostic laparoscopy or assessment at the time of laparotomy for diagnosis (58%). No patient received inappropriate treatment. Nonovarian cancer cases were more likely to be nonwhite (P = 0.003), have a better Eastern Cooperative Oncology Group performance status (P < 0.001), and have a lower CA125 value (P < 0.001), and were less likely to have pleural effusions (P = 0.04).

Conclusions A systematic laparoscopic triage approach to advanced-stage ovarian cancer eliminates incorrect neoadjuvant chemotherapy administration and inappropriate laparotomy. This algorithm identified a population of women who are more likely to have nonovarian cancer pathology. Increasing screening efforts should be focused on conclusive diagnosis with the least invasive testing possible.

  • Ovarian cancer
  • Ovarian cancer diagnosis
  • Diagnostic laparoscopy
  • Ovarian mass

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  • This work was funded by the National Institutes of Health (NIH; T32-CA101642-11 [R.L.D., C.J.L.] and 5-T32-CA009599 [O.D.L.]), Andrew Sabin Family Fellowship (S.N.W.), NIH SPORE in Ovarian Cancer (P50-CA217685-01 [A.K.S.]), The American Cancer Society Research Professor Award (A.K.S.), CPRIT RP120214 (R.L.C.), the Ann Rife Cox Chair in Gynecology (R.L.C.), Judy Reis/Albert Pisani (R.L.C.), and the MD Anderson ovarian cancer research fund (R.L.C.).

  • All authors have received financial support from MD Anderson Ovarian Moonshot Initiative.

  • Source: MD Anderson Ovarian Moonshot Initiative, Protocol PA16-1010.

  • Presentations: Abstract of preliminary analysis published at ASCO in Chicago, June 2017.

  • The authors declare no conflicts of interest.