Occult bilateral involvement in Stage I epithelial ovarian cancer

Objective: The aim of this study was to determine the incidence of occult b ilateral involvement in Stage I epithelial ovarian cancer. Methods. We retrospectively reviewed the records of all patients (n = 135) with Stage I epithelial ovarian cancer treated at the University of Pennsyl vania Cancer Center between 1985 and 1996. A study group of patients (n = 1 18) who underwent a bilateral salpingo-oophorectomy as part of their stagin g laparotomy was identified. Operative notes, pathology reports, and discha rge summaries were reviewed to document stage, grade, histology, intraopera tive impression, gross pathological description, and microscopic diagnosis. Clinically occult bilateral involvement was defined as pathologically docu mented ovarian involvement by tumor in an ovary that appeared normal to the surgeon during staging laparotomy. Results. The study group consisted of mostly Stage IA (79/118, 67%), follow ed by Stage IC (35/118, 30%) and Stage IB (4/118, 3%), tumors. In 9/118 (7. 6%) of these cases, bilateral disease was documented in the pathology repor t. In 3/118 (2.5%) of these cases, the bilateral involvement by tumor was c linically occult at the time of surgery. In only 1/118 (0.85%) of these cas es did a clinically abnormal appearing ovary not contain tumor. Conclusion. Occult involvement by early ovarian cancer is uncommon at the t ime of staging laparotomy. In appropriately counseled patients strongly des iring to preserve fertility, a unilateral salpingo-oophorectomy map be cons idered as part of a staging procedure for apparent Stage IA epithelial ovar ian cancer if the contralateral ovary appears normal to the surgeon. Consid eration should be given to a wedge biopsy with intraoperative frozen sectio n to help exclude occult disease in the normal appearing ovary. (C) 1999 Ac ademic Press.