Problems with peritoneal cytology in second-look laparotomy performed in patients with epithelial ovarian carcinoma

The recurrence rate of ovarian carcinoma is high even when a second-look laparotomy (SLL) is negative. In the current study, the accuracy of peritoneal cytology as an evaluation method of SLL was examined.

The positive SLL rate and the diagnostic accuracy of peritoneal cytology were evaluated in 101 patients with epithelial ovarian carcinoma.

Twenty-three of the 101 patients (23%) were positive based on SLL. The factors considered to be high risk factors for a positive SLL were advanced disease (Stages III and IV by the International Federation of Gynecology and Obstetrics [FIGO] classification), serous adenocarcinoma, and maximum residual tumor > 2 cm after primary surgery (P < 0.05). Of the 23 patients found to be positive on SLL, peritoneal cytology was positive in 6 patients, in whom the percentage was low (26%). The remaining 17 patients (74%) demonstrated false-negative cytology. Of these 17 patients, the tumor tissues were found to be capsulated completely with connective tissues in all biopsy specimens from 9 patients (53%) and in all but 1 biopsy specimen in 6 patients (35%), together accounting for a capsulation rate of 88%. Conversely, clear exposure of the tumor tissues was observed in at least two biopsy specimens in those patients demonstrating positive cytology (P < 0.01).

Peritoneal cytology in SLL was found to result in a high false-negative rate. One of the reasons for this was considered to be capsulation of the lesions with proliferated connective tissues, which may have been the result of by chemotherapy.