Histopathological correlation of splenic disease with radiological and surgical findings: should we incorporate splenectomy into standard procedures for disseminated Müllerian adenocarcinoma?

Purpose of investigation: To determine the positive predictive value (PPV) of both preoperative radiological and intraoperative identification of splenic disease in cases of advanced and recurrent gynaecological malignancy. Materials and Methods: A retrospective study of all splenectomies performed during surgeries for disseminated gynaecological malignancy at the Pan Birmingham Gynaecological Cancer Centre between May 21^st, 2008 and January 31^st, 2015. Results: Forty-one women were identified, most of whom had Stage 3C, high grade, serous Mullerian adenocarcinomas. Thirty-seven (90.2%) spleens were removed because of intraoperative suspicion of disease and the remaining four (9.8%) were removed following inadvertent injury. No spleens were detected radiologically that did not have obvious macroscopic disease. The PPV for the preoperative and intraoperative detection of splenic disease were 88.9% and 91.9%, respectively. Half of the spleens removed following inadvertent injury had disease identified following histopathological examination. Conclusion: Intraoperative identification of splenic disease correlates well with histopathological examination. However, in 50% of splenectomies performed following inadvertent trauma and where disease was not suspected, metastases were identified.

Splenectomy; Gynaecological malignancy; Positive predictive value.

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