Random peritoneal biopsies have limited value in staging of apparent early stage epithelial ovarian cancer after thorough exploration

Cecelia A. Powless, Jamie N Bakkum-Gamez, Giovanni D. Aletti, William Arthur Cliby

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: The relative value of abdominal exploration, lymphadenectomy, omentectomy and random peritoneal biopsies in the staging of apparent early stage epithelial ovarian cancer (EOC) has not been rigorously evaluated. We sought to define the clinical significance of random peritoneal biopsies of otherwise benign appearing tissues in staging of grossly early EOC. Methods: All patients with apparent early stage EOC undergoing staging from 1/1994 to 12/2003 were evaluated to identify surgical-pathologic findings responsible for upstaging at time of exploratory surgery. Demographics, surgical findings and operative outcomes were abstracted. Results: A total of 211 patients with apparent early EOC were included. Only 9 patients were upstaged based on pathology indicating a high negative predictive value of thorough exploration and lymphadenectomy. One patient (1/118; 0.8%) was upstaged from stage I disease to stage II disease based on random biopsy of pelvic peritoneum: all other stage II patients had visible disease. No patients were upstaged from stage I disease to stage III disease due to random biopsies or microscopic omental disease. Eight patients (3.8%) were upstaged from stage II to stage III disease based on random biopsies of upper abdominal peritoneum or the omentum. Conclusions: In our study of apparent early stage EOC, random peritoneal biopsies and omentectomy added little diagnostic value beyond careful inspection of all peritoneal surfaces when EOC is grossly limited to the ovaries. Within our study, less than 4% of patients with pelvic metastasis were upstaged due to these particular staging procedures. No patients in our cohort had a change in treatment recommendations based on these biopsies.

Original languageEnglish (US)
Pages (from-to)86-89
Number of pages4
JournalGynecologic Oncology
Volume115
Issue number1
DOIs
StatePublished - Oct 2009

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Biopsy
Peritoneum
Lymph Node Excision
Ovarian epithelial cancer
Omentum
Neoplasm Staging
Ovary
Demography
Pathology
Neoplasm Metastasis

Keywords

  • Epithelial ovarian cancer
  • Staging procedures

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Random peritoneal biopsies have limited value in staging of apparent early stage epithelial ovarian cancer after thorough exploration. / Powless, Cecelia A.; Bakkum-Gamez, Jamie N; Aletti, Giovanni D.; Cliby, William Arthur.

In: Gynecologic Oncology, Vol. 115, No. 1, 10.2009, p. 86-89.

Research output: Contribution to journalArticle

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abstract = "Objective: The relative value of abdominal exploration, lymphadenectomy, omentectomy and random peritoneal biopsies in the staging of apparent early stage epithelial ovarian cancer (EOC) has not been rigorously evaluated. We sought to define the clinical significance of random peritoneal biopsies of otherwise benign appearing tissues in staging of grossly early EOC. Methods: All patients with apparent early stage EOC undergoing staging from 1/1994 to 12/2003 were evaluated to identify surgical-pathologic findings responsible for upstaging at time of exploratory surgery. Demographics, surgical findings and operative outcomes were abstracted. Results: A total of 211 patients with apparent early EOC were included. Only 9 patients were upstaged based on pathology indicating a high negative predictive value of thorough exploration and lymphadenectomy. One patient (1/118; 0.8{\%}) was upstaged from stage I disease to stage II disease based on random biopsy of pelvic peritoneum: all other stage II patients had visible disease. No patients were upstaged from stage I disease to stage III disease due to random biopsies or microscopic omental disease. Eight patients (3.8{\%}) were upstaged from stage II to stage III disease based on random biopsies of upper abdominal peritoneum or the omentum. Conclusions: In our study of apparent early stage EOC, random peritoneal biopsies and omentectomy added little diagnostic value beyond careful inspection of all peritoneal surfaces when EOC is grossly limited to the ovaries. Within our study, less than 4{\%} of patients with pelvic metastasis were upstaged due to these particular staging procedures. No patients in our cohort had a change in treatment recommendations based on these biopsies.",
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