Peritoneal Washing Cytology in BRCA Mutation-Positive Patients Undergoing Risk-Reducing Salpingo-Oophorectomies.
Gene Landon, Bramara Mutyala, Karen Lu, Michael Deavers, John Stewart, Nour Sneige. MD Anderson Cancer Center, Houston, TX
Background: Peritoneal washing cytology (PWC) obtained at the time of risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation-positive patients has been recommended for detection of occult primary peritoneal carcinoma. However, only a few small series have been reported, and the prognostic significance of their positive PWCs remains uncertain. To further evaluate the utility of PWC in this group of patients, we reviewed PWCs from 117 patients undergoing RRSO at our institution and correlated the results with surgical pathology findings.
Design: Records of 129 PWCs from 126 BRCA mutation-positive patients undergoing RRSO at MD Anderson Cancer Center between 2000 and 2010 were obtained. Slides were available for review for 120 PWCs from 117 patients (3 patients had 2 PWCs each). Cytopathologists, blinded to the RRSO histopathologic diagnoses, categorized the PWCs as benign, atypical, suspicious for malignancy, or malignant. The presence of endosalpingiosis/Mullerian metaplasia and psammomatous calcifications was also noted. These results were correlated with the RRSO histopathologic diagnoses.
Results: PWCs from 113 patients were benign. Of the remaining 4 patients, 2 had PWCs classified as atypical, 1 as suspicious for malignancy, and 1 as malignant. The corresponding RRSO histopathologic findings of the 2 atypical PWCs were endosalpingiosis and adenofibroma in one case, and showed no abnormalities in the other case. Both patients with suspicious or malignant PWCs had RRSO histopathologic diagnoses of endometriosis and endosalpingiosis and, therefore, were suspected of harboring occult peritoneal carcinoma. Nine patients had abnormal tubal or ovarian histologic findings that included tubal hyperplasia with atypia (4 patients), tubal high-grade serous carcinoma (2 patients – one with tumor limited to mucosa and the other with tumor extending into submuscosa), and ovarian serous tumor of low malignant potential (3 patients). All 9 of these patients, however, had benign PWCs.
Conclusions: PWC has the potential to detect occult peritoneal carcinoma in BRCA mutation-positive patients. The clinical significance of a positive PWC without abnormal RRSO histology remains unclear and will require long term follow-up for determination. The benign cellular constituents in the PWCs from our patients found to have occult carcinomas are not surprising, given the small size and limited extent of their cancers.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 74, Wednesday Afternoon