Sampling the omentum in ovarian neoplasia: when one block is enough

Infracolic omentectomy should be performed on all patients as part of the surgical management of suspected ovarian neoplasia to allow accurate pathologic staging. Unlike the primary ovarian lesion, no guidelines exist as to how the pathologist should sample the omentum. We retrospectively examined pathology reports from 692 cases of primary ovarian neoplasia and demonstrated a high positive predictive value for omenta described as macroscopically involved (98.4%). We propose a system of sampling omenta in which block taking is minimized in cases where the ovary appears benign and the omentum normal or where the ovary appears malignant and correspondingly the omentum appears involved. Thorough sampling should be focused on those cases where the ovary appears malignant or borderline and the accompanying omentum normal. This will allow a reduction in departmental workload without a reduction in quality of pathologic staging.