The role of peritoneal cytology at risk-reducing salpingo-oophorectomy (RRSO) in women at increased risk of familial ovarian/tubal cancer.

Risk-reducing salpingo-oophorectomy (RRSO) is the mainstay of managing women at increased risk of familial ovarian cancer and use of strict surgical protocols with serial sectioning of the specimen is increasingly the norm. The role of cytology obtained from peritoneal washings has received less attention, with even commentaries by some authoritative experts omitting to remark on this point [1]. As a result, practice varies among surgeons and institutions, with some published series reporting cytological findings at RRSO [2–4], a number omitting to mention this [5,6], and recently one suggesting it is not necessary [7]. This is an important issue for clinical practice which requires addressing. Cytology is likely to impact management decisions if early stage or pre-invasive disease is discovered at RRSO.Wepresent a summary of the current literature (Tables 1–3), and put forward the rationale for cytology to be included as routine in RRSO protocols. Relevant paperswere identified through an exhaustive search of the online database PubMed, using the search terms ‘RRSO’, ‘salpingooophorectomy’, ‘oophorectomy’, ‘prophylactic salpingo-oophorectomy’, ‘risk-reducing’ and ‘BRCA’ in different combinations. Additional papers were also identified and includedwhere appropriate through examining the reference lists of the initially identified papers. Three initial series [8–10] were excluded as they were followed by subsequent papers [11–13] in which previously published data had been repeated. Five series were excluded as details of occult lesions and stages of disease were not available [13–17]. Of the remaining series those reporting early stage/pre-invasive disease are summarised in Tables 1–3.