Results Of Peritoneal Cytology Research Articles

Comparison of Peritoneal Cytology Results Before and After Resection in Gastric Cancer Patients.

Peritoneal cytology is used to detect the peritoneal spread of gastric cancer and to assess survival rate. The aim of this study was to compare the risk factors, recurrence, and survival of gastric cancer patients with positive and negative peritoneal cytology before and after resection. Patients with gastric cancer who underwent elective surgery were retrospectively analysed. The study covered a period between September 2018 and September 2020. After applying the exclusion criteria, 57 patients were included in the study. For the purpose of this study, peritoneal cytology was taken from the same three intra-abdominal regions before and after resection from patients with operable gastric cancer. Of the 57 patients included in the study, 36 (63.2%) were male patients and 21 (36.8%) were female patients. Preoperative or postoperative malignant cytology was detected in 12 patients (21.1%). Tumour diameter was larger in patients with preoperatively detected malignant cytology than in the patients with postoperatively positive malignant cytology (66.67 mm vs. 44.44 mm) (p = 0.006). The recurrence rate was higher in patients with preoperative and postoperative positive cytology than in those with negative cytology (p = 0.019). The survival of patients with preoperative malignant cytology was worse than the survival of patients with preoperative benign cytology (p = 0.011). A significant correlation was found between lymphovascular invasion (+), perineural invasion (+), T4, Stage 3 disease, number of malignant lymph nodes, and preoperative cytology positivity (p <0.05). In our study, we found that the preoperative cytology positivity is associated with lymphovascular invasion positivity, perineural invasion positivity, T4 tumour, Stage 3 disease, and the number of malignant lymph nodes. Postoperative positive cytology was not associated with the same variables. Because of the significant associations in preoperative positivity, fluid samples should be obtained immediately after the abdomen is open and before the tumour is manipulated. If possible, fluid samples should be taken from different quadrants, but if the sample is to be taken from a single quadrant, it should be taken from the pelvis.

Preoperative predictive factors for positive peritoneal cytology results in patients with pancreatic ductal adenocarcinomas: a retrospective study.

The clinical importance of positive peritoneal cytology results in patients with pancreatic ductal adenocarcinomas remains controversial. We evaluated the prognosis of these patients and the predictive preoperative risk factors for positive peritoneal cytology results. We retrospectively reviewed patients who underwent curative-intent surgery at our institution between May 2010 and June 2020. Preoperative risk factors for positive peritoneal cytology results were identified using logistic regression analysis. A scoring model was constructed using the total number of significant independent predictors for positive peritoneal cytology results. Of 233 patients, 18 (7.7%) had positive peritoneal cytology results. The recurrence-free survival and cancer-specific survival were markedly worse in patients with positive peritoneal cytology results than in those with negative peritoneal cytology results (recurrence-free survival: 6.0months vs. 16.6months, p = 0.050; cancer-specific survival: 19.4months vs. 47.5months, p = 0.034). Tumor location (odds ratio: 3.760, 95% confidence interval: 1.099-11.818, p = 0.023), tumor size > 25mm (odds ratio: 3.410, 95% confidence interval: 1.031-11.277, p = 0.046), preoperative serosal invasion (odds ratio: 5.193, 95% confidence interval: 1.099-24.531, p = 0.038), and preoperative carcinoembryonic antigen level > 5.6ng/mL (odds ratio: 3.816, 95% confidence interval: 1.248-10.667, p = 0.019) were identified as significant independent predictive factors. Our predictive model's optimal cutoff and positive predictive values for positive peritoneal cytology results were 3 and 27.9%, respectively. The indications for curative-intent surgery should be considered carefully in patients with high-risk factors for positive peritoneal cytology results.

A novel predictive model of lymphovascular space invasion in early-stage endometrial cancer.

To predict lymphovascular space invasion (LVSI) positivity in early-stage (stage 1-2) endometrial cancer (EC) using a predictive model with prognostic factors of EC. We included 461 patients who underwent total hysterectomy and bilateral salpingo-oophorectomy with pelvic-paraaortic lymphadenectomy as the primary treatment for presumed early-stage EC at our clinic between 2010 and 2020. Moreover, all surgical specimens were examined histopathologically for the positivity or negativity of LVSI, and the patients were divided into two groups based on these pathologic outcomes. Age, menopausal status, histological type (type 1-2), histological grade (grades 1-2-3), depth of myometrial invasion, and peritoneal cytology results were recorded and analyzed as clinicopathological and demographic characteristics of the patients. The Loess algorithm determined the relationship between the observed and predicted outcomes. The distinction between the algorithms was evaluated by calculating the C-index. LVSI positivity was significantly associated with advanced age, menopause, type 2 EC, advanced histological grade, malignant peritoneal cytology, cervical involvement, and a tumor exceeding 50% of the myometrial depth (p<0.001, respectively). Remarkably, LVSI was most strongly associated with three explanatory variables: 1- More than 50% myometrial invasion [odds ratio (OR): 3.78; 95% confidence interval (CI): 1.80-7.60], 2- Advanced histological grade [OR=1.98 (1.20-3.20) 95% CI], 3- Malignant peritoneal cytology [OR= 3.06 (1.40-6.30) 95% CI]. The penalized maximum likelihood estimation model correctly classified 87% of the included patients (C-index: 0.876). Our predictive model may help predict LVSI based on different prognostic factors. The prognostic factors included in the nomogram were significantly associated with LVSI, particularly myometrial invasion depth of more than 50%, advanced histological grade, and malignant peritoneal cytology.

Prognosis and adjuvant chemotherapy for patients with malignant peritoneal cytology in early-stage non-endometrioid endometrial cancer

ObjectiveTo investigate the influence of malignant peritoneal cytology (MPC) on the prognosis of early-stage patients with endometrial clear cell carcinoma(CCC) and serous carcinoma(SC), and the value of chemotherapy in their treatment. MethodsA retrospective observational cohort study was conducted by querying the National Cancer Institute's Surveillance, Epidemiology, and End Results Program from 2010 to 2019. Women with early-stage CCC and SC with available peritoneal cytology results were enrolled. Propensity score matching(PSM) and propensity score inverse probability of treatment weighting (IPTW) was used to balance the measured covariates in each sub-cohort. ResultsA total of 3,616 eligible patients were included, and 368 patients had MPC (10.2%). Women with MPC were more likely to receive postoperative chemotherapy (OR 2.033; 95%CI 1.589–2.602). In PSM model, MPC had worse overall survival(OS) and cancer-specific survival (CSS) (All,p < 0.001). The 5-year OS rates were 56.5% for women with MPC and 74.4% for those with negative peritoneal cytology, and the 5-year CSS rates were 60.8% versus 80.0%(All, p < 0.0001). In the subgroup analyses, MPC was associated with decreased OS and CSS in serous, clear cell histology group, and stage IA cases(All,p < 0.001), but not for stage IB or stage II disease. In multivariate analysis, chemotherapy improved the prognosis of patients with MPC(OS:p = 0.005; CSS:p = 0.010). Additionally, in stage IA subgroup, chemotherapy improved survival outcomes in patients with MPC(OS:P = 0.025; CSS:P = 0.038), in NPC patients, however, chemotherapy was a good prognostic factor for OS (P = 0.001) but not for CSS(P = 0.300). ConclusionMPC was a prognostic factor for decreased survival in early-stage endometrial CCC and SC, and those with MPC could further benefit from chemotherapy.

Significance of positive peritoneal cytology for recurrence and survival in patients with endometrial cancer.

This study aims to examine the association between malignant peritoneal cytology and prognosis in women with endometrial cancer. We retrospectively analyzed the records of patients with endometrial cancer who underwent surgery with intraoperative peritoneal cytology at our hospital between January 1988 and December 2012. All results were reclassified according to the 2009 International Federation of Gynecology and Obstetrics (FIGO) system, and the relation between intraoperative peritoneal cytology results and recurrence and prognosis was examined. Of the 908 patients analyzed, 205 (22.6%) had positive peritoneal cytology. Patients with positive peritoneal cytology had significantly lower rates of recurrence-free survival (RFS) and overall survival (OS) than those in the negative cytology group (both p < 0.001). Subgroup analysis of patients with FIGO stage I/II showed significantly lower RFS in the positive-cytology group (p=0.005), but there was no significant difference in OS (p=0.637). In the patients with FIGO stage III/IV or patients classified as "high risk," the RFS and OS were significantly lower in the positive-cytology group (both p < 0.001). Cox regression analysis identified positive peritoneal cytology as a significant predictor of recurrence in patients with FIGO stage I/II disease. Patients with positive peritoneal cytology for endometrial cancer have a high risk of recurrence, regardless of histopathologic type or FIGO stage. Peritoneal cytology has already been removed from the 2009 FIGO classification of endometrial cancer, but it may deserve reconsideration.

Clinician's commentary: Atypical peritoneal cytology in ovarian and endometrial cancers.

Peritoneal cytology results play an important role in staging, prognostication, and treatment recommendations in early-stage ovarian cancer. In endometrial cancer, while no longer part of staging criteria, peritoneal cytology results can influence patient-provider shared-decision making regarding adjuvant therapy choices after definitive surgery. We explore two cases demonstrating the impact uncertain cytology can have on patients and providers in these two gynecologic cancers.

Survival effect of adjuvant therapy in stage II-III endometrial cancer: interaction to malignant peritoneal cytology

Objectives: To examine the survival effect of adjuvant therapy in stage II-III endometrial cancer based on peritoneal cytology results. Methods: The Surveillance, Epidemiology, and End Results Program was retrospectively queried to examine 7,467 women with stage II-III endometrial cancer who underwent hysterectomy with available peritoneal cytology results from 2010-2016. Propensity score inverse probability of treatment weighting was used to assess the survival effect of malignant peritoneal cytology, and Cox proportional hazard regression model was fitted to assess the association between adjuvant therapy and all-cause mortality stratified by peritoneal cytology results. Results: Malignant peritoneal cytology was reported in 1,662 (22.3%) women, and was associated with non-endometrioid histology, higher tumor stage, and nodal metastasis in multivariable analysis (all, P Download : Download high-res image (79KB) Download : Download full-size image Conclusions: Malignant peritoneal cytology is prevalent and prognostic in stage II-III endometrial cancer. This study found that the benefit of adjuvant therapy for women with stage II-III endometrial cancer differed depending on the status of peritoneal cytology.

Significance of malignant peritoneal cytology on survival of women with uterine sarcoma

Objectives: To examine the association between malignant peritoneal cytology and survival in women with uterine sarcoma. Methods: This is a retrospective observational study querying the National Cancer Institute's Surveillance, Epidemiology, and End Result Program. Uterine sarcoma cases diagnosed from 2010 to 2016 with known peritoneal cytology results were examined. Propensity score inverse probability of treatment weighting was fitted to balance the measured covariates, and overall survival (OS) was compared between malignant and negative cytology cases. Results: A total of 1,481 uterine sarcomas were examined, and malignant peritoneal cytology was seen in 146 (9.9%) cases. Women who had T3 disease and distant metastases had the highest incidence of malignant peritoneal cytology (43.1%). In multivariable analysis, higher T stage, nodal involvement, distant metastasis, poorer tumor differentiation, and rhabdomyosarcoma/endometrial stromal sarcoma were significantly associated with an increased risk of malignant peritoneal cytology (all, P Download : Download high-res image (80KB) Download : Download full-size image Conclusions: Our study suggests that malignant peritoneal cytology may be a prognostic factor for increased mortality in uterine sarcoma, particularly in uterine leiomyosarcoma.

Association Between Adjuvant Therapy and Survival in Stage II-III Endometrial Cancer: Influence of Malignant Peritoneal Cytology.

The aim of this study was to examine the survival effect of adjuvant therapy in stage II-III endometrial cancer based on peritoneal cytology results. The National Cancer Institute'sSurveillance, Epidemiology, and End Results Program was retrospectively queried to examine 7467 women with stage II-III endometrial cancer who underwent hysterectomy, and with available peritoneal cytology results, from 2010 to 2016. A Cox proportional hazard regression model was fitted to assess the association between adjuvant therapy and all-cause mortality stratified by peritoneal cytology results. Malignant peritoneal cytology was reported in 1662 (22.3%) women and was associated with non-endometrioid histology, higher tumor stage, and nodal metastasis (p<0.05). In a propensity score-weighted model, malignant peritoneal cytology was associated with increased all-cause mortality compared with negative peritoneal cytology (hazard ratio 1.35, 95% confidence interval 1.23-1.48). Adjuvant therapy types varied based on histology and peritoneal cytology results. In non-endometrioid histology, the combination of chemotherapy and whole pelvic radiotherapy (WPRT) was associated with improved overall survival compared with chemotherapy or WPRT alone irrespective of the peritoneal cytology results (p<0.05). The combination of chemotherapy and WPRT was also associated with improved overall survival in women with endometrioid histology and malignant peritoneal cytology (p = 0.026). Women with endometrioid histology and negative peritoneal cytology represented the most common subpopulation (46.5%), and overall survival was similar regardless of which of the three adjuvant therapy modalities was used (p = 0.319). Malignant peritoneal cytology is prevalent and prognostic in stage II-III endometrial cancer. This study found that thesurgeon's choice and benefit of adjuvant therapy for women with stage II-III endometrial cancer differed depending on the status of peritoneal cytology.

Hysteroscopic Morcellation in Endometrial Cancer Diagnosis: Increased Risk?

Operative hysteroscopy requires elevated intrauterine pressures, which could lead to the spread of malignant cells into the peritoneal cavity. Currently, there is a paucity of data analyzing clinical outcomes in endometrial cancer after hysteroscopic morcellation with newer equipment. In this study, we sought to determine whether there are increased rates of positive peritoneal cytology, lymphovascular space invasion, or surgical upstaging in patients undergoing hysteroscopic morcellation compared with alternative endometrial biopsy methods. A retrospective chart review of patients from 2013-2018 was performed. The exclusion criteria included biopsy at outside institution, stage IV endometrial cancer known before biopsy, and missing data regarding biopsy method and histology. Peritoneal cytology results, lymphovascular space invasion, and surgical staging were compared by method of biopsy and histology using chi-square and Kruskal-Wallis tests. The patients included in this study were accrued from the Karmanos Cancer Insittute in Detroit, Michigan. A total of 289 patients met the inclusion criteria: 184 patients were classified as low-grade (Fédération Internationale de Gynécologie et d'Obstétrique grades 1 and 2) and 105 as high-grade (Fédération Internationale de Gynécologie et d'Obstétrique grade 3, serous, clear cell, and carcinosarcoma) endometrial cancer. Fifty-three patients (18%) underwent hysteroscopy with morcellation. Alternative biopsy methods included hysteroscopy without morcellation, n = 81 (28%); endometrial biopsy, n = 112 (38.7%); and dilation and curettage, n = 43 (15%). Positive peritoneal cytology was noted in 34 cases (12%) and negative cytology in 165 (57%). Cytology was not performed in 90 cases (31%). When comparing outcomes by histologic subtypes, no difference was seen in peritoneal cytology (p = .704 and .727 for low grade and high grade, respectively), stage (p = .773 and .053 for low grade and high grade, respectively) or lymphovascular space invasion (p = .400 and .142 for low grade and high grade, respectively). Our study demonstrates that hysteroscopy with morcellation is a safe diagnostic method for low- and high-grade endometrial pathologic conditions and does not lead to increased dissemination of malignant cells, lymphovascular space invasion, or upstaging of patients.

Is Diagnostic Hysteroscopy Safe for the Investigation of Type 2 Endometrial Cancer? a Retrospective Cohort Analysis

Study Objective Although hysteroscopy can be used for assessing the uterine cavity in women with suspected, endometrial cancer, it remains controversial as a procedure that can enhance metastasis spread. Endometrial cells may shed during hysteroscopy and be passively transported with fluid into the peritoneal cavity. Moreover, it is important to assess this hypothesis into type 2 endometrial cancer, a more aggressive phenotype that usually presents with endometrial atrophy and worse prognosis. Thus, we aimed to assess the prevalence of positive peritoneal cytology in type II endometrial cancer in women undergoing hysteroscopy as a diagnostic tool and determine their prognosis. Design Retrospective cohort analysis (2002-2017). Setting Tertiary, academic hospital. Patients or Participants 127 women with type II endometrial cancer. Interventions Diagnostic hysteroscopy (HSC)(n=43) or dilation/curettage (D&C)(n=84). Measurements and Main Results Clinical and pathologic characteristics, including peritoneal cytology results were reviewed. Survival curves were projected using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis with hazard ratio plus 95%confidence intervals were calculated to assess factors related to disease-free survival (DFS). There was no difference with regard to age between the groups. The D&C group showed a higher frequency of advanced staging and greater vascular invasion (p = 0.008 and p = 0.04 respectively). Positive cytology was found in 2/43 (4.6%) women following HSC and in 9/84 (10.7%) following D&C (p = 0.22). There was no statistically significant difference in the survival curve between groups. Multivariate analysis for DFS has shown that advanced staging (III and IV) (HR=3.89[1.98-7.66];p<0.001), advanced age (HR=1.073[1.028-1.119];p=0.001) and vascular invasion (OR=3.01[1.53-5.91];p=0.001) increases the risk of recurrence. Conclusion Diagnostic HSC did not increase the rate of positive peritoneal cytology at the time of surgical staging in this cohort of women with type II endometrial cancer and presented equal safety when compared to D&C. Although hysteroscopy can be used for assessing the uterine cavity in women with suspected, endometrial cancer, it remains controversial as a procedure that can enhance metastasis spread. Endometrial cells may shed during hysteroscopy and be passively transported with fluid into the peritoneal cavity. Moreover, it is important to assess this hypothesis into type 2 endometrial cancer, a more aggressive phenotype that usually presents with endometrial atrophy and worse prognosis. Thus, we aimed to assess the prevalence of positive peritoneal cytology in type II endometrial cancer in women undergoing hysteroscopy as a diagnostic tool and determine their prognosis. Retrospective cohort analysis (2002-2017). Tertiary, academic hospital. 127 women with type II endometrial cancer. Diagnostic hysteroscopy (HSC)(n=43) or dilation/curettage (D&C)(n=84). Clinical and pathologic characteristics, including peritoneal cytology results were reviewed. Survival curves were projected using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis with hazard ratio plus 95%confidence intervals were calculated to assess factors related to disease-free survival (DFS). There was no difference with regard to age between the groups. The D&C group showed a higher frequency of advanced staging and greater vascular invasion (p = 0.008 and p = 0.04 respectively). Positive cytology was found in 2/43 (4.6%) women following HSC and in 9/84 (10.7%) following D&C (p = 0.22). There was no statistically significant difference in the survival curve between groups. Multivariate analysis for DFS has shown that advanced staging (III and IV) (HR=3.89[1.98-7.66];p<0.001), advanced age (HR=1.073[1.028-1.119];p=0.001) and vascular invasion (OR=3.01[1.53-5.91];p=0.001) increases the risk of recurrence. Diagnostic HSC did not increase the rate of positive peritoneal cytology at the time of surgical staging in this cohort of women with type II endometrial cancer and presented equal safety when compared to D&C.

Significance of Malignant Peritoneal Cytology on Survival of Women with Uterine Sarcoma

This study was designed to examine the association between malignant peritoneal cytology and survival of women with uterine sarcoma. This retrospective, observational study queried the National Cancer Institute's Surveillance, Epidemiology, and End Result Program. Uterine sarcoma cases diagnosed from 2010 to 2016 with known peritoneal cytology results were examined. Propensity score inverse probability of treatment weighting was fitted to balance the measured covariates. Overall survival (OS) was compared between malignant and negative cytology cases. A total of 1481 uterine sarcomas were examined. Malignant peritoneal cytology was seen in 146 (9.9%) cases. Women who had T3 disease and distant metastases had the highest incidence of malignant peritoneal cytology (43.1%). In multivariable analysis, higher T stage, nodal involvement, distant metastasis, poorer tumor differentiation, and rhabdomyosarcoma/endometrial stromal sarcoma were significantly associated with an increased risk of malignant peritoneal cytology (all, P < 0.05). In the weighted model, malignant peritoneal cytology was associated with a nearly twofold increased risk of all-cause mortality compared with negative peritoneal cytology (3-year OS rate 34.7% versus 60.2%; hazard ratio 2.26; 95% confidence interval 1.88-2.71; P < 0.001). The absolute difference in the 3-year survival rate was particularly large in leiomyosarcoma (3-year OS rate 2.8% versus 51.9%; hazard ratio 2.64; 95% confidence interval 1.94-3.59; P < 0.001). Malignant peritoneal cytology was also associated with an increased all-cause mortality risk in early and advanced stages (both, P < 0.05). Our study suggests that malignant peritoneal cytology may be a prognostic factor for increased mortality in uterine sarcoma, particularly in uterine leiomyosarcoma.

Malignant peritoneal cytology and increased mortality risk in stage I non-endometrioid endometrial cancer

ObjectiveTo examine the survival of women with stage I non-endometrioid endometrial cancer with malignant peritoneal cytology. MethodsA retrospective observational cohort study was conducted to examine the National Cancer Institute's Surveillance, Epidemiology, and End Results Program from 2010 to 2016. Women with stage I serous, clear cell, carcinosarcoma, undifferentiated, and mixed endometrial cancer with known peritoneal cytology results at hysterectomy were examined (N = 4506). Propensity score inverse probability of treatment weighting was used to balance the measured covariates, and survival outcomes were assessed according to peritoneal cytology results. ResultsMalignant peritoneal cytology was reported in 401 (8.9%) women. In multivariable analysis, older age, serous histology, and large tumors were associated with an increased likelihood of malignant peritoneal cytology (all, P < 0.05). In a propensity score weighted model, malignant peritoneal cytology was associated with a nearly two-fold increase in all-cause mortality risk compared to negative peritoneal cytology (5-year rates, 63.4% versus 80.2%, hazard ratio 2.18, 95% confidence interval 1.78–2.66). In sensitivity analyses, malignant peritoneal cytology was associated with decreased overall survival in old and young age groups, serous, clear cell, carcinosarcoma, and mixed histology groups, stage T1a disease, and staged and unstaged cases, but not for stage T1b disease. Difference in 5-year overall survival rates between the malignant and negative peritoneal cytology groups was particularly large among those with clear cell histology (24.0%), stage T1a disease (19.4%), aged >78 years (18.2%), and serous tumors (17.6%). ConclusionMalignant peritoneal cytology can be prevalent in stage I non-endometrioid endometrial cancer. Our study suggests that malignant peritoneal cytology is a prognostic factor for decreased survival in stage I non-endometrioid endometrial cancer.

Fertility Preserved Hysteroscopic Approach for the Treatment of Stage Ia Endometrioid Carcinoma.

ObjectiveThis study aims to explore the feasibility of a hysteroscopic procedure combined with progestin therapy in young patients with stage Ia endometrioid carcinoma (EC) to avoid sterilization.Materials and MethodsEleven young women with stage Ia EC (International Federation of Gynecology and Obstetrics grade 1) who were treated with a hysteroscopic approach combined with progestin from July 2004 to June 2016 were retrospectively analyzed and followed up to monitor their general recovery and pregnancy outcome.ResultsThe patients' median age was 27.3 years (range, 25–39 years). Comorbidities consisted of primary infertility in 8 patients, polycystic ovary syndrome in 4, uterine fibroids in 2, and diabetes in 1. The results of immunohistochemical analysis were positive for all estrogen and progestin receptors. After treatment, 9 patients attained complete remission, and 2 patients achieved partial remission. The results of peritoneal cytology in 4 patients were negative. As of this writing, 6 of the 11 patients have given birth to 7 infants, and 1 patient had an ectopic pregnancy. Two patients ultimately underwent radical resection. The average follow-up time was 82.3 months (range, 15 to 152 months), and all patients remain disease-free.ConclusionsHysteroscopic surgery combined with progestin treatment for stage Ia EC in young patients to avoid sterilization was practical and may represent a new option for patients with stage Ia EC who wish to preserve their fertility.

Does hysteroscopy worsen prognosis in women with type II endometrial carcinoma?

BackgroundPrior studies evaluating the impact of hysteroscopy on outcomes in endometrial cancer have predominantly evaluated type I tumors. We sought to evaluate whether hysteroscopy worsens prognosis in type II endometrial cancer.MethodsA retrospective cohort analysis of 140 patients from two institutions with type II endometrial cancer was performed. Women who underwent either diagnostic hysteroscopy (HSC) or dilation and curettage (D&C) for cancer diagnosis from June 2001 until June 2010 were included. The clinical and pathologic characteristics, including peritoneal cytology results were reviewed. The primary endpoint was disease-specific survival (DSS). The exposure of interest was hysteroscopy. Survival curves were projected using the Kaplan-Meier method and compared using the log-rank test.ResultsThere was no difference in age, histology, stage, depth of myometrial invasion, adnexal involvement, or nodal metastasis between HSC and D&C patients. Positive cytology was found in 16/54 (30%) patients following HSC and in 10/86 (12%) following D&C (p = 0.008). Fourteen patients with stage I and II disease had positive peritoneal cytology, with 11/40 (27.5%) patients in the HSC group and 3/59 (5%) patients in the D&C group(p = 0.002). Median DSS was clinically different for the HSC and D&C groups, but statistical significance was not reached (53 versus 63.5 months, p = 0.34). For stage I and II patients, 18/99 (18%) were dead of EC, with a median DSS of 60 months for HSC and 71 months for D&C (p = 0.82). Overall 46 (33%) patients developed a recurrence, with 18/54 (33%) in the HSC group compared to 28/86 (32%) in the D&C group (p = 0.92). There was no difference in recurrence location between groups.ConclusionsDiagnostic hysteroscopy significantly increased the rate of positive peritoneal cytology at the time of surgical staging in this cohort of patients with type II EC. However, we were unable to detect a difference in prognosis as measured by DSS.

Tu1797 Validation of Immediate Peritoneal Washing Cytology Results in Pancreatic and Gastric Cancer

Introduction: The mainstay of treatment for pancreatic and gastric cancers is surgical resection. Unfortunately many of these patients present with locally advanced, unresectable or distant disease and therefore medical management may be of more benefit. Accurate staging of patients with pancreatic and gastric cancer is essential in determining the best treatment strategy. Despite preoperative imaging there remains a group of patients that have clinically occult metastatic disease. Positive peritoneal cytology is a poor prognostic indicator for survival in both gastric and pancreatic cancer. Surgical resection may not be of benefit in those with positive peritoneal cytology. At our institution, a diagnostic laparoscopy with peritoneal washings is performed prior to surgical resection. We performed a retrospective review to evaluate the accuracy of immediate peritoneal washing interpretation in both gastric cancer and pancreatic cancer. Results: There were 51 patients that underwent immediate peritoneal washing interpretations. There were 5 patients with gastric adenocarcinoma, 2 patients with cholangiocarcinoma, and 44 patients with pancreatic adenocarcinoma. Four of the patients had positive cytology for tumor cells with immediate interpretation, and 47 patients had cytology negative for tumor cells with immediate interpretation. There was only one patient with negative cytology on immediate interpretation with cytology positive for malignant cells on final pathologic results. There were many RBCs noted within the peritoneal fluid specimen, which is probably why the cancer cells were missed. Immediate peritoneal cytology results had a 100% positive predictive value, and a 97% negative predictive value. There were no false positive results. Discussion: Positive peritoneal cytology is considered a poor prognostic factor for survival in both gastric and pancreatic cancer. In pancreatic and gastric cancer, previous studies have shown resection in the presence of metastatic disease does not improve survival. Diagnostic laparoscopy has been used as an adjunct to help stage patients before proceeding with a radical resection that has an associated significant morbidity andmortality rate is futile and potentially harmful, delaying or obviating systemic therapy that may be of more benefit to the patient. Our results show that utilizing immediate interpretation of peritoneal cytology is reliable and accurate. There was only one patient with a false negative result and there were no false positive results. Therefore, prior to surgical resection immediate interpretation can be utilized. Conclusion: Diagnostic laparoscopy with peritoneal washings and immediate interpretation of cytology can be used prior to proceeding with surgical resection. A futile operation can potentially be avoided with the use of immediate interpretation of the peritoneal fluid.

Analysis Of Risk Factors Of Positive Peritoneal Cytology In Patients Treated For Gastric Cancer--Preliminary Report.

Presence of free gastric cancer cells in the peritoneal cavity of patients who underwent surgical treatment for gastric cancer is a negative prognostic factor and caused rapid disease recurrence, manifested as peritoneal metastases. Positive peritoneal cytology despite lack of visible peritoneal metastases was regarded as M1 class in the TNM classification (7th edition) in 2010. The aim of the study was to analyze factors associated with positive peritoneal cytology and identify groups of patients in whom diagnostic laparoscopy plus peritoneal lavage in the diagnostic process could affect therapeutic decisions. The study enrolled patients with gastric cancer who underwent surgical treatment at the Department of Surgery, Wielkopolskie Oncology Center in Poznań. During the laparotomy, after opening of the peritoneal cavity, 200 ml of physiological saline at 37 °C was administered in the tumor region. After this fluid was mixed, 100 ml of lavage fluid was collected. This fluid was subsequently spun many times to obtain sediment for cytology and immunohistochemistry investigation using anti-BerEp-4, CK 7/20, and B72.3. Results of peritoneal cytology were analyzed jointly with clinical factors--patient's age, sex and pathology factors--tumor invasion, involvement of lymph nodes, histological grade, histological type according to Lauren and localization of the cancer in the stomach. Analysis of the peritoneal fluid for presence of free cancer cells was done in 51 patients. Positive peritoneal cytology was found in 12 (23.5%) patients. In the group of patients with positive cytology, all patients had T3/T4 tumors and all were found to have lymph node metastases, while G3 cancer was found in 83.3% of patients. In patients with positive cytology, diffuse gastric cancer according to Lauren predominated (9 of 12 patients, 75%), while in patients with negative cytology--intestinal type (20 of 39 patients, 51.2%). In the group of patients with positive histology, the whole stomach was involved by the cancer process in 7 of 12 patients (58.3%), while in the group with negative histology, in 29 of 39 patients the tumor was located in the gastric body and prepyloric part (74.4%). Based on this study we can conclude that determinants of positive peritoneal cytology include: tumor stage T3/T4, N+, G3, cancer located in the whole stomach, diffuse histological type according to Lauren.

Site-specific factors for cancer of the corpus uteri from SEER registries: collaborative stage data collection system, version 1 and version 2.

Uterine cancer is the fourth leading cancer among US women. Changes in uterine cancer staging were made from the American Joint Committee on Cancer (AJCC) 6th to 7th edition staging manuals, and 8 site-specific factors (SSFs) and 3 histologic schemas were introduced. Carcinomas account for 95% of cases and are the focus of this report. Distributions of SSF values were examined for 11,601 cases of malignant cancer of the corpus uteri and uterus, NOS (not otherwise specified) diagnosed in Surveillance, Epidemiology, and End Results (SEER) Program registries during 2010. AJCC 6th and 7th edition staging distributions were compared for 11,176 cases using data in both staging systems. AJCC 6th edition staging distributions during 2004-2010 were examined. AJCC 7th edition SSFs required by SEER were International Federation of Gynecology and Obstetrics stage (SSF1), peritoneal cytology (SSF2), number of positive pelvic lymph nodes (SSF3), number of pelvic lymph nodes examined (SSF4), number of positive para-aortic lymph nodes (SSF5), and number of para-aortic lymph nodes examined (SSF6). For SSFs related to lymph nodes, a third of cases were classified as "not applicable," reflecting that lymph node dissection is not indicated for cases with stage1A and stage 4 diagnoses. AJCC 7th edition criteria assigned more cases to stage I (72.9%) than AJCC 6th edition criteria (68.7%). Annual counts significantly increased during 2004-2010, as did counts for AJCC 6th edition stages INOS, IA, IB, IC, IIIA, IIIB, IIIC, and IVB. The proportion of cases diagnosed with stage I cancer was stable, whereas stages II and IV decreased and stage III increased. Five SSFs were suitable for analysis: peritoneal cytology results (SSF2), numbers of positive pelvic lymph nodes (SSF3), pelvic lymph nodes examined (SSF4), positive para-aortic lymph nodes (SSF5), and para-aortic lymph nodes examined (SSF6).

The relationship between positive peritoneal cytology and the prognosis of patients with FIGO stage I/II uterine cervical cancer

ObjectiveThe purpose of this study was to assess whether peritoneal cytology has prognostic significance in uterine cervical cancer.MethodsPeritoneal cytology was obtained in 228 patients with carcinoma of the uterine cervix (International Federation of Gynecology and Obstetrics [FIGO] stages IB1-IIB) between October 2002 and August 2010. All patients were negative for intraperitoneal disease at the time of their radical hysterectomy. The pathological features and clinical prognosis of cases of positive peritoneal cytology were examined retrospectively.ResultsPeritoneal cytology was positive in 9 patients (3.9%). Of these patients, 3/139 (2.2%) had squamous cell carcinoma and 6/89 (6.7%) had adenocarcinoma or adenosquamous carcinoma. One of the 3 patients with squamous cell carcinoma who had positive cytology had a recurrence at the vaginal stump 21 months after radical hysterectomy. All of the 6 patients with adenocarcinoma or adenosquamous carcinoma had disease recurrence during the follow-up period: 3 with peritoneal dissemination and 2 with lymph node metastases. There were significant differences in recurrence-free survival and overall survival between the peritoneal cytology-negative and cytology-positive groups (log-rank p<0.001). Multivariate analysis of prognosis in cervical cancer revealed that peritoneal cytology (p=0.029) and histological type (p=0.004) were independent prognostic factors.ConclusionPositive peritoneal cytology may be associated with a poor prognosis in adenocarcinoma or adenosquamous carcinoma of the uterine cervix. Therefore, the results of peritoneal cytology must be considered in postoperative treatment planning.

The Value of Peritoneal Washing Cytology During Intra-Abdominal Surgery for Female Genital Tract Neoplasms

BackgroundPeritoneal washing cytology is a technique performed during surgery for genital neoplasms to detect subclinical intraperitoneal metastases from these tumors. The aim of this study was to evaluate PWC utility in presumed benign and malignant female genital tract neoplasms by comparing the results of peritoneal cytology and corresponding histopathological specimens. Patients and MethodsThe 305 cases of female genital lesions with available staging (International Federation of Gynecology and Obstetrics) were considered. In cases with positive cytology, without neoplastic involvement of the ovarian and uterine surfaces, the salpinx was accurately examined to reveal primary malignant fallopian tubal neoplasms. For malignant ovarian neoplasms, the correlation rate between cytological and histopathological findings was statistically evaluated using the Fisher exact test. Statistical significance was defined as P < .05. ResultsHistopathological diagnosis revealed that of 32 cases with positive cytology, 21 examples corresponded to primary ovarian serous carcinomas (65.625%). Moreover, the serous carcinoma was the subtype that most frequently revealed neoplastic elements on PWC (21 examples in 22 cases, 95.4%). Only 1 of these malignancies with positive cytology and pT1a stage presented simultaneous invasive and in situ serous carcinoma of contralateral tubal fimbria. Only 1 of serous endometrial carcinomas that involved an endometrial polyp was associated with positive cytology and with simultaneous carcinoma of tubal fimbria. ConclusionIn conclusion, PWC remains a useful procedure for staging malignant genital tract neoplasms and can be necessary to detect occult fallopian tube malignancies.