The significance of cytological mesothelial atypia diagnosed from peritoneal washings performed during risk-reducing salpingo-oophorectomy

Abstract

Objective. Occult cancer may be found in a small proportion of women undergoing risk-reducing salpingo-oophorectomy (RRSO). However, the results and significance of peritoneal wash cytology in this setting are not clear. The objective of this study was to determine the significance of cytologic mesothelial atypia in the peritoneal washings of patients undergoing RRSO. Methods. We conducted a retrospective chart review of all patients undergoing RRSO from July 2002 to December 2003. Patient charts were reviewed for information regarding cytology, pathology, demographics, surgical procedure and findings, and outcome. Results. One hundred thirty women underwent RRSO during the study period. One hundred seventeen had washings performed during the procedure and constitute the study cohort. The median age at the time of the procedure was 48 years (range, 33–78 years). Final cytology was reported as normal in 102 patients (87%), mesothelial atypia in 13 (11%), and non-satisfactory in 2 (2%). Ovarian and tubal histopathology was normal in all cases. No association was found between mesothelial atypia and age, prior breast cancer, or prior abdominal surgery. Twenty-nine patients had previously undergone genetic testing for BRCA1/2 mutations as part of ongoing prospective follow-up studies. Four (24%) of 17 patients with a known BRCA1 or BRCA2 mutation were found to have mesothelial atypia compared to 1 (8%) of 12 with no mutation. With a median follow-up time of 20 months (range, 1–40 months), none of the patients with mesothelial atypia were diagnosed with peritoneal malignancy following RRSO. Conclusion. In this study, mesothelial atypia was identified in 11% of patients who had peritoneal washings performed at the time of RRSO. No patients with mesothelial atypia went on to develop peritoneal carcinoma. The link between mesothelial atypia and mutations in BRCA1/2 and the need to perform peritoneal washings in this setting are both yet to be determined.