Female Genital Tract
chapter
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Peritoneal Washings and Ovary
Marluce Bibbo, Moira D Wood and Brendan T Fitzpatrick
Contents
P e rito n e a l W a s h in g s
B a sic H is to lo g y
S a m p lin g T e c h n iq u e s
N o n - n e o p la s tic C y s ts
S p e c im e n s
N e o p la s tic C y s ts
C y t o lo g y
[-'. •
. •
A
A n c illa r y T e c h n iq u e s
D ia g n o s tic A c c u ra c y
C o n c lu d in g R e m a rk s
O v a ry
p e r ito n e a l W a s h in g s
S a m p lin g T e c h n iq u e s
O v a r y
Peritoneal Washings
Peritoneal cytology has an important role in the diagnosis and
staging of abdominal and gynecologic neoplasms. Where peri-
toneal involvement by malignant tumors is extensive such as
mesothelioma or high-grade abdominal or ovarian carcinomas,
diagnosis can usually be confirmed by examination of ascites.
However, additional procedures to assist diagnosis are required
for localized tumors, less advanced disease, or follow-up of
treatment. This may include examination of peritoneal wash-
ings, brushings, or smears.
For
ovarian
neoplasms, a positive peritoneal washing will
upstage the diagnosis to a FIGO Stage Figo IC. The prognostic
significance of malignant cells in washings or brushings varies,
depending on the primary ovarian lesion, as for example in
serous borderline tumor or serous papillary carcinoma. Adjuvant
therapy for serous ovarian borderline tumors with positive peri-
toneal washings remains unproven.1
Positive washings obtained
during "second-look" procedures at the end of a prescribed course
of chemotherapy for ovarian carcinoma may indicate the need for
continuation in therapy.2
The presence of grossly evident peritoneal dissemination can
be confirmed by histologic biopsy; therefore washings provide
no additional information. However, the use of cytologic brush-
ings or smears from liver or diaphragm may confirm extension
of disease beyond the pelvis in patients without gross evidence
of extraovarian spread.
Positive cytology is frequently a reflection of adnexal involve-
ment in endometrial carcinoma. However, good therapeutic
results can still be obtained in these patients when there is no
clinical or pathologic evidence of lymph node involvement.3,4
Malignant cells in washings are uncommon in patients with
carcinoma of the cervix
but when identified are associated with
advanced disease and may require endocavitary chemotherapy
to prevent recurrence.5 Laparoscopy and washing cytology have
a role in the evaluation of upper a
bdominal malignancies.
Positive peritoneal washings are associated with peritoneal
recurrence and poor prognosis in patients with gastric adeno-
carcinoma.6,7
In patients with potentially resectable pancreatic carcinoma,
positive cytology is associated with more advanced disease.8
Sampling Techniques
The sampling procedure used can influence quantity and qual-
ity of cells obtained and therefore the diagnostic accuracy of
the procedure. Peritoneal lavage cytology specimens may be
obtained as an outpatient procedure using a temporary dialy-
sis catheter for patients with ovarian cancer undergoing endo-
cavitary chemotherapy.1
Laparotomy
, as the traditional method for obtaining cytologic
material and staging of malignant neoplasms of the abdomen
and pelvis, is very effective, provided an adequate surgical inci-
sion is made that allows systematic visualization and palpation
of peritoneal and visceral surfaces. However, lesions involving
recesses such as the cul-de-sac region or posterior diaphragm
may still be overlooked. Smears from liver, diaphragm, and
parietal surfaces can be used to provide additional information
from these recessed locations.9
Fiberoptic technology has revolutionized the use of
laparo-
scopic/robotic procedures
in gynecologic and surgical oncology.
Laparoscopy is extensively used in the diagnosis of clinically
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