The lack of clinical value of peritoneal washing cytology in high risk patients undergoing risk-reducing salpingo-oophorectomy: a retrospective study and review

Abstract

BackgroundTo assess the clinical value of peritoneal washing cytology (PWC) in women with BRCA1 or BRCA2 mutations and women from a family with hereditary breast and/or ovarian cancer (HBOC) undergoing risk-reducing salpingo-oophorectomy (RRSO) in detecting primary peritoneal cancer (PPC) or occult ovarian/fallopian tube cancer.MethodsA retrospective study of patients with known BRCA1 or BRCA2 mutation or HBOC who underwent RRSO at the Erasmus Medical Centre, Rotterdam, The Netherlands between January 2000–2014. Patients with an elevated risk of malignancy prior to the procedure were excluded from primary analysis (elevated CA-125, an ovarian mass, abdominal pain or another gynecological malignancy). A review of the literature was conducted.ResultsOf the 471 patients who underwent RRSO, a total of 267 cytology samples were available for analysis. Four samples showed malignant cells, all four patients were diagnosed with ovarian and/or fallopian tube cancer at histologic examination. A fifth patient, of whom no cytology sample was obtained during RRSO, developed primary peritoneal cancer 80 months post RRSO.ConclusionsThis study failed to show that cytology is of value during RRSO in detecting primary peritoneal cancer, however 36 % of patients with concomitant ovarian or fallopian tube cancer had positive cytology. Therefore, the routine sampling of peritoneal washings during RRSO is not found to be useful to detect subsequent PPC.

The fallopian tube as origin of ovarian cancer: Change of diagnostic and preventive strategies

“…Three (4.5%) of 67 patients with follow‐up records showed subsequent primary peritoneal cancer during the follow‐up period. The clinical significance of positive peritoneal cytology at RRSO also remains unclear, and it has not been determined whether positive cytology is associated with a higher risk of subsequent peritoneal cancer . Furthermore, there is insufficient evidence that surgical staging or postoperative chemotherapy for patients with isolated STIC at RRSO decreases the occurrence of peritoneal cancer.…”

Challenges in Managing Patients with Hereditary Cancer at Gynecological Services

“…However, outcomes among patients with positive PWC (malignant or suspicious for malignancy) without pathologically identified malignancy or precancerous lesions have not been reported frequently. In the literature, 11 patients have had positive PWC with no macroscopic malignancies found during RRSO (Table 2) [10–14]. The frequency of cases with no macroscopic findings consistent with malignancy but with positive PWC is about 1%, which is not low.…”

Early-onset primary peritoneal carcinoma from atypical cells after risk-reducing salpingo-oophorectomy for BRCA2 mutation carrier: a case report

“…However, whether or not pelvic washing cytology should be performed at RRSO is controversial. Blok et al reported that malignant washing cytology samples fail to add value to histopathological examinations for the detection of ovarian and/or fallopian tube cancer using the SEE-FIM protocol [14].…”