How Often Does Positive Peritoneal Wash Cytology Independently Upstage and Impact Clinical Management of Ovarian Malignancies?
Jing Yu, Rohit Bhargava, Robert Marsall Austin. Magee-Womens Hospital of UPMC, Pittsburgh, PA
Background: Findings of diagnostic tumor cells in peritoneal wash cytology (PWC) specimens can result in upstaging of ovarian carcinomas (OvCa) to FIGO Stage IC or IIC. Positive PWC, however, is not the only parameter for designating an OvCa as Stage IC. Ovarian capsular rupture and/or surface involvement by the tumor can also result in Stage IC, irrespective of PWC status. Also, upstaging alone will not necessarily lead to altered clinical management according to National Comprehensive Cancer Network (NCCN) guidelines. The aim of this study was to document how often PWC alone caused upstaging and altered clinical management of OvCa at a large academic women's hospital.
Design: We searched our institutional database for cases of positive PWC in primary OvCa with comprehensive staging over a 5-year period from July 2006 to July 2011. Cases with incomplete staging and questionable synchronous ovarian and endometrial carcinomas were excluded. Stage, histologic tumor type, ovarian capsule status, surface tumor involvement, and character of extra-ovarian implants were documented and analyzed.
Results: A total of 215 qualified cases were identified, including 25 cases of stage IC (11.62%), 7 of IIC (3.26%), and 183 of III and IV (85.12%) OvCa. Of 25 IC cases, 21 had either a ruptured capsule or surface involvement in one or both ovaries, only 4 (16% of Stage IC cases, 1.86% of all cases) were upstaged solely based on a positive PWC. Histopathologic subtypes of the 4 cases were: clear cell carcinoma, mixed epithelial carcinoma (clear cell, high grade serous, and endometrioid carcinoma), serous borderline tumor, and mucinous adenocarcinoma. Based on current NCCN practice guidelines, grade 3 OvCa will undergo chemotherapy even if Stage IA or IB; borderline tumors regardless of stage will be observed if no invasive implants are found; and all stage 2 OvCa will be treated similarly regardless of substaging. Therefore, positive PWC in 10 of the 11 upstaged cases did not alter the immediate management based on NCCN guidelines. The only case where positive PWC findings resulted in both upstaging and alteration of management was a mucinous OvCa treated with chemotherapy, a tumor that otherwise would have been Stage IA and observed.
Conclusions: Positive PWC very infrequently provides additional information impacting staging of comprehensively staged OvCa tumors, when all relevant features impacting staging were considered, particularly capsular integrity and ovarian surface tumor involvement. Furthermore, positive PWC by itself only rarely altered NCCN guideline-designated treatment.
Category: Gynecologic & Obstetrics
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 152, Tuesday Afternoon