Neoadjuvant chemotherapy for advanced ovarian cancer: the role of cytology in pretreatment diagnosis.

OBJECTIVE: The objective was to determine the role of cytology in the pretreatment evaluation of women with clinical findings consistent with ovarian cancer who are being considered for neoadjuvant chemotherapy. METHODS: Pretreatment cytology slides were available for review from 60 of 72 consecutive patients treated with platinum-based neoadjuvant chemotherapy who were believed to have ovarian cancer based on clinical findings. Fifty of the 72 patients had evidence of both intraabdominal and extraabdominal tumor spread prior to treatment. Fifty-three of 66 patients had CA125 values >500 U/mL, 34 being >1500 U/mL. Pretreatment cytology was compared to surgical specimens obtained following chemotherapy. RESULTS: Cytologic findings were consistent with ovarian cancer in 55 patients, not consistent with ovarian cancer in 4 cases, and insufficient for diagnosis in one case. Forty-seven of the 60 patients underwent surgery. Forty-two of 43 patients with cytology consistent with ovarian cancer had epithelial ovarian cancers at surgery. One had no pathologic evidence of disease. Three of the 4 patients thought not to have cytology consistent with ovarian cancer underwent surgery following neoadjuvant chemotherapy. Two had ovarian epithelial cancers and one had a mesonephric adenocarcinoma. The one patient with cytology insufficient for diagnosis also had an epithelial ovarian cancer at diagnosis. CONCLUSIONS: Cytology proved to be extremely helpful in supporting the clinical impression of an apparent advanced ovarian cancer. When the cytologic diagnosis does not match the clinical impression, communication between the cytologist or pathologist and the clinician is essential.