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Peritoneal Carcinomatosis: Image-guided Peritoneal Core Biopsy for Tumor Type and Patient Care¹

¹ From the Departments of Clinical Radiology (J.A.S., S.E.S.), Pathology (N.W., A.P.B.), and Gynaecology (G.L.) and the Imperial Cancer Research Fund Cancer Medicine Research Unit (T.J.P.), St James’s University Hospital, Beckett St, Leeds LS9 7TF, England. Received November 29, 2000; revision requested January 11, 2001; revision received March 12; accepted March 22. J.A.S. supported by a Pump Priming Grant from the Royal College of Radiologists. T.J.P. supported by the Imperial Cancer Research Fund. Address correspondence to J.A.S. (e-mail: wilsonspencer@compuserve.com).

PURPOSE: To assess image-guided peritoneal core biopsy for the diagnosis of tumor type and treatment of patients with peritoneal carcinomatosis.

MATERIALS AND METHODS: Thirty-five women (age range, 47–85 years; mean age, 69 years) prospectively identified in a gynecologic oncology center underwent 18-gauge core biopsy in omental cake (n = 25), peritoneal (n = 7), or adnexal (n = 3) sites. No complications of biopsy occurred. Standard hematoxylin-eosin analysis of the biopsy cores was supplemented by immunohistochemical markers to CA-125, carcinoembryonic antigen, cytokeratin 7, and cytokeratin 20. Diagnoses were validated with further multidisciplinary review, subsequent surgery, and response to specific chemotherapy.

RESULTS: In 27 (77%) of the 35 women, a confident primary site diagnosis was obtained with standard hematoxylin-eosin analysis of core biopsy material from the following sites: ovary (n = 22), breast (n = 2), colon (n = 2), and lymphoma (n = 1). The finding at hematoxylin-eosin analysis in another seven (20%) women was poorly differentiated adenocarcinoma with no definite primary site but with an immunohistochemical profile suggesting ovarian cancer (CA-125 positive, carcinoembryonic antigen negative, cytokeratin 7 positive, cytokeratin 20 negative). There was one false-negative biopsy result.

CONCLUSION: Image-guided peritoneal core biopsy with hematoxylin-eosin analysis supplemented with immunohistochemical analysis is a simple, safe, and accurate technique for providing site-specific diagnoses in women with undiagnosed peritoneal carcinomatosis.

Index terms: Computed tomography (CT), guidance, 791.12112, 791.12115 • Peritoneum, biopsy, 791.1261 • Peritoneum, neoplasms, 791.32, 791.33 • Ultrasound (US), guidance, 791.12985

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