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

BACKGROUND: 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. METHODS: The positive SLL rate and the diagnostic accuracy of peritoneal cytology were evaluated in 101 patients with epithelial ovarian carcinoma. RESULTS: 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). CONCLUSIONS: 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.