Utility of peritoneal lavage cytology during laparoscopic salpingo-oophorectomy: a retrospective analysis.

OBJECTIVES: To assess the significance of peritoneal washing cytology at the time of laparoscopic salpingo-oophorectomy. DESIGN: Retrospective study. SETTING: Cambridge University Hospital. POPULATION: Four hundred and nine women who underwent laparoscopic salpingo-oophorectomy by the gynaecology oncology team between 2004 and December 2009 were included. One hundred and thirteen women had risk-reducing salpingo-oophorectomy, 103 women had salpingo-oophorectomy as part of breast cancer management, 59 had simple ovarian cysts, 111 had complex ovarian cysts and 23 had the procedure done for other reasons. METHODS: Histology and cytology results were reviewed and all hospital records were checked for subsequent malignancy. Sensitivity and specificity of peritoneal washing cytology was calculated. MAIN OUTCOME MEASURES: Malignant peritoneal cytology in the absence of cancer on histopathology. RESULTS: Eleven of the 409 women in our study had occult malignancy on histopathological examination and three of them had positive peritoneal washings. One woman had positive washings from metastatic breast cancer. Thirteen women developed different malignancies subsequently but none had primary peritoneal or ovarian cancer within a median follow-up interval of 34 months. CONCLUSIONS: Peritoneal lavage cytology did not pick up any additional malignancy in the study population. Based on the evidence presented, we suggest that peritoneal washing cytology during laparoscopic salpingo-oophorectomy is of limited value and should not be practised routinely.

Predicting the risk of endometrial cancer in postmenopausal women presenting with vaginal bleeding: the Norwich DEFAB risk assessment tool.

BACKGROUND: This study aimed to show the longitudinal use of routinely collected clinical data from history and ultrasound evaluation of the endometrium in developing an algorithm to predict the risk of endometrial carcinoma for postmenopausal women presenting with vaginal bleeding. METHODS: This prospective study collected data from 3047 women presenting with postmenopausal bleeding. Data regarding the presence of risk factors for endometrial cancer was collected and univariate and multivariate analyses were performed. RESULTS: Age distribution ranged from 35 to 97 years with a median of 59 years. A total of 149 women (5% of total) were diagnosed with endometrial carcinoma. Women in the endometrial cancer group were significantly more likely to be older, have higher BMI, recurrent episodes of bleeding, diabetes, hypertension, or a previous history of breast cancer. An investigator best model selection approach was used to select the best predictors of cancer, and using logistic regression analysis we created a model, 'Norwich DEFAB', which is a clinical prediction rule for endometrial cancer. The calculated Norwich DEFAB score can vary from a value of 0 to 9. A Norwich DEFAB value equal to or greater than 3 has a positive predictive value (PPV) of 7.78% and negative predictive value (NPV) of 98.2%, whereas a score equal to or greater than 5 has a PPV of 11.9% and NPV of 97.8%. CONCLUSION: The combination of clinical information with our investigation tool for women with postmenopausal vaginal bleeding allows the clinician to calculate a predicted risk of endometrial malignancy and prioritise subsequent clinical investigations.

Recurrent endometriosis following total hysterectomy with oophorectomy mimicking a malignant neoplastic lesion: a diagnostic and therapeutic challenge.

CASE REPORT: A woman with a previous hysterectomy and bilateral salpingo-oophorectomy for endometriosis presented with painless vaginal bleeding. Imaging revealed a heterogeneous soft tissue pelvic mass suggestive of a malignant neoplastic lesion. Radical surgery was performed including excision of the pelvic mass and anterior resection of the sigmoid colon. Histopathology revealed endometriosis. CONCLUSION: The risk of malignant transformation and the difficulty in achieving a preoperative diagnosis make radical surgery inevitable in the management of recurrent endometriosis. The use of hormone replacement therapy after bilateral salpingo-oophorectomy for endometriosis remains controversial and requires careful counseling about recurrence and close follow-up.