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Medline ® Abstract for Reference 20

of 'Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Clinical features and diagnosis'

20
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Women with peritoneal carcinomatosis of unknown origin: Efficacy of image-guided biopsy to determine site-specific diagnosis.
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Hewitt MJ, Anderson K, Hall GD, Weston M, Hutson R, Wilkinson N, Perren TJ, Lane G, Spencer JA
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BJOG. 2007;114(1):46.
 
OBJECTIVES: To evaluate the use of image-guided biopsy (IGB) in routine clinical practice to obtain site-specific diagnoses in women presenting with peritoneal carcinomatosis (PC).
STUDY DESIGN: Retrospective case study.
SETTING: Tertiary referral centre.
POPULATION: A total of 149 consecutive women with PC who underwent IGB.
METHODS: Biopsy was performed in women considered unsuitable for primary surgery because of poor performance status or disease unlikely to be optimally debulked, with a prior history of malignancy or where there was clinicoradiological uncertainty about primary tumour site. Standard haematoxylin-eosin histological analysis was supplemented with immunohistochemistry.
MAIN OUTCOME MEASURES: The rate of site-specific diagnosis.
RESULTS: A total of 149 women underwent IGB using computed tomography or ultrasound over a 6-year period. The only complication was one rectus sheath haematoma. In 138 (93%) women, a site-specific cancer diagnosis was made on the IGB (including 111 müllerian tract, 8 gastrointestinal tract, 4 breast and 3 lymphoma); in ten women, a repeat biopsy was necessary, giving an overall failure rate of 7%. In a further six women, malignancy was confirmed but a site-specific diagnosis could not be made, and in four women, biopsy showed benign tissue. A site-specific diagnosis was obtained in 29 of the 32 women (94%) with previous malignancy, of which 18/32 (56%) showed a new primary cancer.
CONCLUSIONS: IGB is a safe and accurate technique for providing site-specific diagnoses in women with PC in routine clinical practice, including those with a previous relevant malignancy. IGB can replace laparoscopic or open biopsy in defining primary therapeutic options. The data would suggest that the biopsy should be performed with ultrasound where feasible.
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Department of Obstetrics and Gynaecology UCC, BUPA Ireland Research Centre, Cork University Maternity Hospital, Cork, Ireland.
PMID