Peritoneal Washing Cytology Research Articles

Peritoneal washing cytology in patients with BRCA1 or BRCA2 mutations undergoing risk-reducing salpingo-oophorectomies: A 10-year experience and reappraisal of its clinical utility

ObjectiveTo evaluate the utility of peritoneal washing cytology (PWC) for detecting occult primary peritoneal carcinoma in patients with BRCA1 or BRCA2 mutations, we reviewed PWCs obtained during risk-reducing salpingo-oophorectomy (RRSO) from 117 patients at our institution and correlated the results with surgical pathology findings. MethodsRecords of 128 PWCs from 125 patients with BRCA1 or BRCA2 mutations undergoing RRSO at MD Anderson Cancer Center between 2000 and 2010 were obtained. Slides were available for review for 119 PWCs from 117 patients (2 patients had 2 PWCs each). Cytopathologists, blinded to the RRSO histopathologic diagnoses, categorized the PWCs as benign, atypical, suspicious for malignancy, or malignant. These results were correlated with the RRSO histopathologic diagnoses. ResultsPWCs from 113 patients were benign. Of the remaining 4 patients, 2 had PWCs classified as atypical, 1 as suspicious for malignancy, and 1 as malignant. The corresponding RRSO histopathologic findings of the 2 atypical PWCs showed endosalpingiosis and cystadenofibroma in one case and showed no abnormalities in the other case. Both patients with suspicious or malignant PWCs, indicating the possibility of occult peritoneal carcinoma, had RRSO histopathologic diagnoses of endometriosis and endosalpingiosis. Nine patients had abnormal tubal or ovarian histologic findings, but all 9 of these patients had benign PWCs. ConclusionPWC has the potential to detect occult peritoneal carcinoma in patients with BRCA1 or BRCA2 mutations. The clinical significance of a positive PWC without abnormal RRSO histology remains unclear and will require long-term follow-up for determination.

Effects of neoadjuvant intraperitoneal/systemic chemotherapy (bidirectional chemotherapy) for the treatment of patients with peritoneal metastasis from gastric cancer.

Novel multidisciplinary treatment combined with neoadjuvant intraperitoneal-systemic chemotherapy protocol (NIPS) and peritonectomy was developed. Ninety-six patients were enrolled. Peritoneal wash cytology was performed before and after NIPS through a port system. Patients were treated with 60 mg/m2 of oral S-1 for 21 days, followed by a 1-week rest. On days 1, 8, and 15, 30 mg/m2 of Taxotere and 30 mg/m2 of cisplatin with 500 mL of saline were introduced through the port. NIPS is done 2 cycles before surgery. Three weeks after NIPS, 82 patients were eligible to intend cytoreductive surgery (CRS) by gastrectomy + D2 dissection + periotnectomy to achieve complete cytoreduction. Sixty-eight patients showed positice cytology before NIPS, and the positive cytology results became negative in 47 (69%) patients after NIPS. Complete pathologic response on PC after NIPS was experienced in 30 (36.8%) patients. Stage migration was experienced in 12 patients (14.6%). Complete cytoreduction was achieved in 58 patients (70.7%). By the multivariate analysis, complete cytoreduction and pathologic response became a significantly good survival. However the high morbidity and mortality, stringent patient selection is important. The best indications of the therapy are patients with good pathologic response and PCI ≤ 6, which are supposed to be removed completely by peritonectomy.

Prognostic significance of peritoneal washing cytology in patients with gastric cancer

Positive peritoneal washing cytology is a poor prognostic factor in patients with gastric cancer. The right therapeutic approach for this condition has not been well documented. Patients who underwent surgery for gastric cancer with suspected serosal invasion and peritoneal washing cytology at the Korean National Cancer Centre between May 2001 and December 2009 were included in this retrospective study. Clinicopathological factors and overall survival were analysed with respect to the cytological results and presence of peritoneal metastases. Prognostic factors were analysed in patients with positive cytology but without overt peritoneal metastases. A total of 1072 patients were included in the analysis, of whom 900 had negative cytology (C0 group) and 172 had positive cytology (C1 group). No peritoneal metastases (P0) were found in 830 patients (92·2 per cent) in the C0 group. Peritoneal metastases (P1) were found in 76 patients (44·2 per cent) in the C1 group. Median overall survival times in the P0 C1, P1 C0 and P1 C1 subgroups were 20·0, 14·0 and 10·0 months respectively. Multivariable analysis of the P0 C1 subgroup revealed that clinical N0-2 category and gastric resection were significantly associated with better prognosis (median survival 24·0 versus 13·0 months for N0-2 versus N3, and 21·0 versus 4·0 months for resected versus non-resected). Positive washing cytology in patients with gastric cancer is a negative prognostic factor for patients with, as well as those without, overt peritoneal metastases. Resection is an option in patients with clinical stage N0-2 disease without peritoneal metastases but with a positive washing cytology finding.

Limitations of peritoneal washing cytology demonstrated

According to this research, carried out at Cambridge University Hospitals NHS Foundation Trust, conducting peritoneal washing cytology at the time of laparoscopic salpingo-oophorectomy has limited and questionable clinical value. The authors conclude that the procedure, while unlikely to cause harm, is relatively costly and does not diagnose peritoneal cancer or occult ovarian cancers that might have not been seen at histology.

Prognostic factors of T4 gastric cancer patients undergoing potentially curative resection

To investigate the prognostic factors of T4 gastric cancer patients without distant metastasis who could undergo potentially curative resection. We retrospectively analyzed the clinical data of 71 consecutive patients diagnosed with T4 gastric cancer and who underwent curative gastrectomy at our institutions. The clinicopathological factors that could be associated with overall survival were evaluated. The cumulative survival was determined by the Kaplan-Meier method, and univariate comparisons between the groups were performed using the log-rank test. Multivariate analysis was performed using the Cox proportional hazard model and a step-wise procedure. The study patients comprised 53 men (74.6%) and 18 women (25.4%) aged 39-89 years (mean, 68.9 years). Nineteen patients (26.8%) had postoperative morbidity: pancreatic fistula developed in 6 patients (8.5%) and was the most frequent complication, followed by anastomosis stricture in 5 patients (7.0%). During the follow-up period, 28 patients (39.4%) died because of gastric cancer recurrence, and 3 (4.2%) died because of another disease or accident. For all patients, the estimated overall survival was 34.1% at 5 years. Univariate analyses identified the following statistically significant prognostic factors in T4 gastric cancer patients who underwent potentially curative resection: peritoneal washing cytology (P < 0.01), number of metastatic lymph nodes (P < 0.05), and venous invasion (P < 0.05). In multivariate analyses, only peritoneal washing cytology was identified as an independent prognostic factor (HR = 3.62, 95% CI = 1.37-9.57) for long-term survival. Positive peritoneal washing cytology was the only independent poor prognostic factor for T4 gastric cancer patients who could be treated with potentially curative resection.

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Utility of peritoneal lavage cytology during laparoscopic salpingo-oophorectomy: a retrospective analysis

To assess the significance of peritoneal washing cytology at the time of laparoscopic salpingo-oophorectomy. Retrospective study. Cambridge University Hospital. Four hundred and nine women who underwent laparoscopic salpingo-oophorectomy by the gynaecology oncology team between 2004 and December 2009 were included. One hundred and thirteen women had risk-reducing salpingo-oophorectomy, 103 women had salpingo-oophorectomy as part of breast cancer management, 59 had simple ovarian cysts, 111 had complex ovarian cysts and 23 had the procedure done for other reasons. Histology and cytology results were reviewed and all hospital records were checked for subsequent malignancy. Sensitivity and specificity of peritoneal washing cytology was calculated. Malignant peritoneal cytology in the absence of cancer on histopathology. Eleven of the 409 women in our study had occult malignancy on histopathological examination and three of them had positive peritoneal washings. One woman had positive washings from metastatic breast cancer. Thirteen women developed different malignancies subsequently but none had primary peritoneal or ovarian cancer within a median follow-up interval of 34 months. Peritoneal lavage cytology did not pick up any additional malignancy in the study population. Based on the evidence presented, we suggest that peritoneal washing cytology during laparoscopic salpingo-oophorectomy is of limited value and should not be practised routinely.

A feasibility study of postoperative chemotherapy with S-1 and cisplatin (CDDP) for gastric carcinoma (CCOG0703)

The outcome of stage III gastric cancer patients treated by D2 dissection followed by adjuvant chemotherapy with S-1 remains unsatisfactory. Moreover, some patients with a preoperative diagnosis of stage II/III turn out to be stage IV after surgical exploration, and a standard postoperative treatment for this population has not been established. A feasibility study of postoperative S-1/cisplatin (CDDP) was performed with patients who underwent gastrectomy for what turned out to be a stage IV gastric cancer. The primary endpoint of the trial was the relative dose intensity during five courses of S-1/CDDP. Several criteria to skip, postpone, or reduce the dose had been predetermined. Between 2007 and 2009, 31 patients were accrued, including 19 patients who were positive for peritoneal washing cytology, 6 with peritoneal seeding, 5 with metastasis to the paraaortic nodes, and 4 with other distant metastases. Only 7 patients completed five cycles as planned (median, two cycles). The median relative dose intensities of S-1 and CDDP were 37% and 40%, respectively. Causes of treatment failure were failure to fulfill criteria for starting a new course within 5 weeks of the last administration of S-1 in 7, patient refusal in 6, disease recurrence/progression in 4, need to reduce dose by two levels in 4, and two successive skips of CDDP in 3 patients. The median progression-free survival time of all patients was 363 days. Although promising in the neoadjuvant and advanced/metastatic setting, S-1/CDDP is too toxic as a postgastrectomy treatment for Japanese patients.

Peritoneal wash cytology in gastric carcinoma. Prognostic significance and therapeutic consequences

Background and Aims The prognosis of patients with gastric cancer is poor, even following curative resection, and is related primarily to the extent of disease at presentation. In locally advanced gastric tumors, peritoneal lavage cytology (PLC) is a relevant prognostic factor. The Authors present their results of peritoneal washing cytology, evaluating the prognostic value of this technique, and discussing the clinical impact. Patients and Methods From July 2003 to May 2008, results of PLC in 64 patients with histologically proven primary gastric adenocarcinomas were analyzed. At laparotomy the abdomen was irrigated with 200 ml of normal saline, and ≥50 ml were aspirated and examined by means of cytology and immunocytopathology. Results PLC was positive in 7 cases (11%). Overall, 86% of patients with a positive PLC had a pT3/pT4 tumor and 100% with a positive PLC had an N-positive tumor ( p < 0.001); 71% of patients with a positive PLC had a grade G3/G4 tumor ( p = 0.001). At a median follow-up of 32 months, the cumulative 5-year survival was 28%. The median survival of patients presenting positive PLC (19 months) was significantly lower than that of patients with negative peritoneal cytology (38 months) ( p = 0.0001). Multivariate analysis identified cytology as a significant predictor of outcome ( p = 0.018). Conclusions Results in the present series demonstrated that patients with a positive peritoneal cytology had advanced disease and poor prognosis, thus indicating that patients with locally advanced gastric cancer should undergo staging laparoscopy and PLC examination in order to select those requiring more aggressive treatment. Future therapeutic strategies should include PLC examination in preoperative staging, in order to select patients for more aggressive treatment.

The impact of guidelines on the treatment of endometrial cancer in Germany: A nationwide analysis of the AGO in 2006 and 2009.

e15533 Background: The AGO established and updated guidelines on the assessment and treatment of endometrial cancer (EC) in 2006 and 2009. This prospective study tries to elucidate how patients with endometrial cancer are cared for in daily routine in Germany and to find out to which extent modification of a guideline actually changes treatment behavior on a nationwide basis. Methods: A questionnaire has been established and sent to gynecological departments in Germany. It comprises documentation of the use of peritoneal washing cytology (PWC), lymphadenectomy (LNE), adjuvant chemotherapy (CT) and adjuvant endocrine treatment (ET). The guidelines recommend performance of PWC and pelvic/paraaortic LNE. Only in very early EC disease LNE can be omitted. CT is recommended for extra-uterine disease of type I EC and for all type II EC. The guideline updated in 2009 extended the recommendation of CT by some high-risk cases of uterine disease. ET is not recommended. Results: 178/500 (35.6%) questionnaires in 2006 and 258/775 (33.3%) in 2009 were returned to our unit. A PWC was obtained in 86.9% and 94.6% in 2006 and 2009, respectively (p = 0.008). LNE in early stage type I EC was performed more frequently in 2006 as compared to 2009 (e.g., pT1a G2: 38.6% vs. 22.9%, p = 0.001; pT1b G1 47.6% vs. 39.6%, p = 0.019). In type I EC with extra-uterine disease LNE was often not advised (pelvic LNE in 2009 and 2006: pT3 76.2% vs. 80.1% and 41.5% vs. 38.0%, respectively). In 2006 and 2009 all the other stages received pelvic LNE in about 90% (e.g., pT1b G3: 96.3% vs. 95.3%; pT2a 97.6% vs. 97.6%). In 2006 paraaortic LNE was carried out less frequently compared to 2009 (e.g., pT1b G3: 70.2% vs. 90.2%, p < 0.001; pT2a: 86.3% vs. 95.7%, p < 0.001). 48.8% in 2006 vs. 63.7% in 2009 received CT (p = 0.003). 25.7% and 15.4% underwent ET in 2006 and 2009, respectively (p = 0.012). Conclusions: Common clinical-therapeutic approaches were recommended more often according to guidelines in 2009 as compared to 2006. However, there were still important aspects in the management of EC, which did not meet the recommendations of the guideline. These findings show that a better adherence to therapeutic guidelines is still warranted. No significant financial relationships to disclose.

Lipoleiomyosarcoma of the uterus: A case report and review

Heterologous sarcomas of the uterus are rare neoplasms. We report a rare case of heterologous uterine sarcoma composed of leiomyosarcomatous and liposarcomatous components with a brief review of literature. A 53-year-old woman had vaginal spotting. The endometrial biopsy performed at a local clinic revealed a high grade spindle cell sarcoma. Pelvis magnetic resonance imaging showed about 5.4 cm sized multiseptated T1 and T2 high signal mass in a uterine fundus without lymph node metastasis or pelvic wall involvement. Total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection, and peritoneal washing cytology were performed. Pathologic diagnosis was made as leiomyosarcoma with liposarcomatous differentiation (lipoleiomyosarcoma). The patient received adjuvant postoperative radiotherapy (5040 cGy). Follow up images showed no evidence of disease 8 months after surgery.

Cytological diagnosis of peritoneal endometriosis

Sir, Endometriosis is a common disease characterized by ectopic growth of endometrial tissue that responds to hormonal stimulation. It primarily affects women in the reproductive age group with mixed symptomatology. Cytological features of endometrial cells in peritoneal fluid are not well described, which we wish to highlight. A 30-year-old woman presented with lower abdominal pain and dysmenorrhoea of 1 year duration. On examination, she had mild ascites. Bilateral cysts were seen near the fallopian tube on laparoscopy. Diagnostic considerations included neoplastic process or pelvic endometriosis. A peritoneal wash was performed and 100 mL of haemorrhagic fluid was sent for cytological examination. On microscopy, the fluid showed the presence of endometrial cells. The glandular epithelial cells were arranged in variably sized spheres in which the periphery showed epithelial cells, along the border and as a honeycombed sheet, with a cluster of stromal cells in the centre having hyperchromatic nuclei, scant cytoplasm and indistinct cytoplasmic borders [Figure 1]. There was no nuclear atypia and the nucleoli were inconspicuous. Some of the fragments were arranged in a small ball-like configuration in which there was cytoplasm resembling mesothelial cells [Figure 2]. Their three-dimensional nature and tight grouping set them apart from the loose sheets of mesothelial cells of the peritoneal wash. A few hemosiderin-laden macrophages were identified. A cytological diagnosis of endometriosis was made. Figure 1 Large endometrial fragment in peritoneal wash fluid showing epithelial lining on the outside, seen on the sides and as honeycombed cells as well as compact stromal cells within (PAP, ×400) Figure 2 Small spherule of endometrial cells in three-dimensional arrangement, which has to be differentiated from reactive mesothelial cells (PAP, ×400) The utility of peritoneal wash cytology for diagnosis of endometriosis has been reported.[1,2] In most cases, only hemosiderin-laden macrophages are identified.[2–5] The presence of endometrial cells is more specific but less sensitive than hemosiderin-laden macrophages for the diagnosis of endometriosis. The endometrial cells have been reported in 25%–52% of peritoneal washes done in endometriosis.[1,5] However, recognition of endometrial cells as well as hemosiderin-laden macrophages is essential for diagnosis on morphological basis alone.[6,7] The descriptions, diagnostic features and illustration of endometrial cell morphology in the peritoneal wash fluid is restricted to a few reports.[3,6] The distinction of endometrial cells from mesothelial cells and adenocarcinoma cells is important. Endometrial cells come in three-dimensional fragments that do not resemble mesothelial cells architecturally in washings which are arranged in sheets. However, endometriosis may elicit reactive mesothelial proliferation, which form three-dimensional fragments with calcific concretions, which are difficult to distinguish from endometrial cells.[5] Larger endometrial cell fragments may include stromal cells, which is a useful feature for differentiation as seen in the present case. Presence of hemosiderin-laden macrophages is indirect evidence of endometriosis. In the presence of an adnexal mass, a well-differentiated adenocarcinoma is always a diagnostic consideration and needs to be ruled out by the absence of atypia in the small cells and nuclei of endometrial cells. This distinction becomes difficult if there is reactive mesothelial proliferation in case of endometriosis.[2,5] The use of cell blocks and immunocytochemistry for epithelial and mesothelial cell markers can greatly aid diagnosis in distinction between reactive mesothelial fragments on one side and endometriosis and adenocarcinoma on the other.[2] Correlation with clinical and operative features is essential before cytological diagnosis.

The Role of Pelvic and/or Para-Aortic Lymphadenectomy in Surgical Management of Apparently Early Carcinosarcoma of Uterus

To determine the incidence of lymph node (LN) metastasis in patients with apparently early carcinosarcoma of the uterus, to analyze the clinicopathologic factors associated with LN metastasis, and to evaluate the role of pelvic and/or para-aortic lymphadenectomy in treatment of such conditions. We retrospectively analyzed 41 patients with carcinosarcoma intraoperatively confined to the uterus who underwent complete staging procedures including pelvic and/or para-aortic lymphadenectomy. After surgery, two patients (4.9%) were upstaged to stage IIIA because of positive peritoneal washing cytology, and 13 (31.7%) were upstaged to stage IIIC as a result of LN metastasis. Five patients had pelvic, three had paraaortic, and five had both pelvic and para-aortic LN metastases. The mean number of metastatic LNs was 3.7 (range 1-15). On multivariate analysis, myometrial invasion >1/2 [odds ratio (OR) 8.50; 95% confidence interval (CI) 1.57-45.92; P = 0.013] and lymphovascular space invasion (LVSI) (OR 8.50; 95% CI 1.57-45.92; P = 0.013) were significantly predictive of LN metastasis. After a median follow-up interval of 32 months (range 3-179 months), the 2-year disease-free survival (DFS) and overall survival (OS) rates were 73% and 84%, respectively, and the 5-year DFS and OS rates were 73% and 69%, respectively. Patients with LVSI or LN metastasis had significantly poorer DFS and OS. Pelvic and para-aortic lymphadenectomy should be performed in patients with apparently early carcinosarcoma of the uterus, especially in those with myometrial invasion >1/2 or LVSI.

Laparoscopic Interval Debulking Surgery in Ovarian Cancer

Study Objective: We report a videoclip of laparoscopic interval debulking surgery in ovarian cancer patient. She was transferrd to our institution due to advanced cancer of unknown origin. After diagnostic laparoscopy including laparoscopic BSO, appendectomy, mutile peritoneal biopsies, and peritoneal cytology, we made a decision initial chemotherapy becasue there were al lot of tiny metastatic nodules on the peritoneum and mesemtery. She received six cycles of paclitaxel-carboplatin, and then we performed a successful laparoscopic interval debulking surgery including peritoneal washing cytology, laparoscopic extraperitoneal hysterectomy, both laparoscopic pelvic lymphadenectomy, laparoscopic para-aortic lymphadenectomy, laparoscopic omentectomy, and mutiple peritoneal biopsies.

Positive Peritoneal Washing Cytology in Multiple Cavities Can Predict Poor Prognosis of Advanced Gastric Cancer Patients

Positive peritoneal washing cytology (PWC) has been reported to be a poor prognostic factor for gastric cancer. Japanese gastric cancer classifications recommend PWC in Douglas' pouch for advanced gastric cancer. However, the sensitivity of PWC is relatively low. The goal of this study was to investigate whether PWC in multiple cavities increases its sensitivity to predict prognosis. Between January 1996 and December 2006, a series of 992 patients with gastric cancer underwent D2 gastrectomy with intraoperative PWC. Of the 992 patients, 62 patients had positive PWC. PWC was conducted in four cavities (left subphrenic cavity, right subhepatic cavity, Douglas' pouch, and inside the omental bursa). The 62 patients were retrospectively analyzed for their background and survival. Eleven (17.7%) patients had negative PWC in Douglas' pouch but were positive in the other cavities. The 62 patients were classified into two groups according to the number of positive PWC cavities: 20 patients with one or two and 42 patients with three or four positive PWC cavities. No significant difference in clinicopathological features was observed between these two groups. However, the overall and progression-free survival rates of patients with one or two positive PWC cavities were significantly higher than those for patients with three or more positive PWC cavities. PWC in multiple cavities was more sensitive than only in one cavity. The number of positive cavities may indicate the grade of tumor spread in the peritoneum and predict the prognosis of patients with positive PWC.

Peritoneal Dissemination: A Pending Issue in Gastric Cancer Worth Exploring

Gastric cancer is a peritoneal-borne disease. Although our attention usually first turns to regional lymphatic extension in cases of localized disease, we know that most gastric adenocarcinomas will eventually spread to the peritoneum sooner or later in their natural history, even in the absence of lymph node involvement. Moreover, peritoneal carcinomatosis is a common manifestation of recurrent disease after curative-intent resection, even when the most efficacious adjuvant or neoadjuvant treatments have been used. The adverse prognostic effect of peritoneal dissemination in this disease is well acknowledged, no matter whether it consists of established macroscopic implants or isolated free cancer cells (detected by peritoneal washing cytology) with no overt peritoneal carcinomatosis. In both cases, current treatment guidelines call for palliative therapeutic measures based on systemic chemotherapy.

Occult fallopian tube carcinoma detected in routine pelvic washing specimens submitted for staging: Another justification for pelvic washing cytology?

Peritoneal washing cytology is important in the staging, prognosis, and treatment schema for women diagnosed with gynecologic malignancies. Additionally, peritoneal washings are often performed before the specific diagnosis or even the distinction between benign or malignant lesion is known. Occasionally, the cytology and surgical pathology specimens, although obtained during the same procedure, will show unexpected and/or discordant findings. Perhaps, the greatest dilemma occurs when atypical cells suggestive of malignancy are identified in peritoneal washing specimens when a corresponding benign or discordantly low grade malignant diagnosis is made in the surgical pathology specimen. We present two such cases in which further investigation proved extremely valuable, not only leading to resolution of initially discrepant cytologic and surgical pathology findings but also in the process leading to second diagnoses of early fallopian tube carcinoma. Increasing evidence appears to be pointing to the fallopian tube as the site of origin of many serous carcinomas previously thought to be of primary pelvic or ovarian origin. These cases further confirm the utility of peritoneal washing cytology as a diagnostic modality when routine gross examination and sampling of the surgical specimens alone would have failed to provide the complete diagnosis.

Safety and efficacy of bidirectional chemotherapy for treatment of patients with peritoneal dissemination from gastric cancer: Selection for cytoreductive surgery

There is no standard treatment for peritoneal carcinomatosis (PC) from gastric cancer. New bidirectional chemotherapy (neoadjuvant intraperitoneal-systemic chemotherapy protocol (NIPS)) was developed. The aim of the present study was to assess the safety and efficacy of NIPS and to show the selection for cytoreductive surgery on PC from gastric cancer. Seventy-nine patients with PC from gastric cancer were treated with NIPS. A peritoneal port system was introduced into the abdominal cavity. The peritoneal wash cytological examination through a port was done before and after NIPS. The patients were treated with oral TS-1 twice a daily for 21 days, followed by a 1-week rest. On day 1, 8, and 15 from the start of oral TS-1 administration, 30 mg/m(2) of Docetaxel and 30 mg/m(2) of cisplatinum with 500 ml of saline were introduced into the peritoneal cavity through the port. A median course of oral TS-1 was 2.1 course and a median time of IP chemoterapy was 5.8. Peritoneal free cancer cells (PFCCs) had been detected in 65 (82.2%) patients before NIPS, and the positive cytology changed to be negative in 41 (63.0%) patients after NIPS. After NIPS, 41 patients underwent laparotomy, and complete cytoreduction was done in 32 (78%) patients. Complete cytoreduction was done in 27 (51.9%) of 52 patients with negative cytology but in only 4 (14.8%) of 27 patients with positive cytology (P < 0.001). Patients with negative cytology after NIPS survived significantly longer than those with positive cytology. The adverse effects after NIPS were mild and there was no treatment-related deaths. The grade 3/4 hematological adverse effects were found in 2 (2.6%) patients. Grade 3 renal toxicity and port site infection was found in three patients, respectively. NIPS using a port system is a safe and effective treatment for PC. Peritoneal wash cytology through a port system is a good indicator to select the patients to perform cytoreductive surgery.

Preoperative Serum CA-125 Levels in Endometrial Cancer

In Brief Objective: The aim of this study was to evaluate properative serum levels of CA-125 for the prediction of advanced stages of endometrial cancer. Method: Retrospective study evaluated 114 women with pathologically proven endometrial carcinoma treated in our institution that had preoperative serum CA-125 levels between January 1990 and December 2005. The association of preoperative serum CA-125 with a different histopathologic factors was evaluated. Statistical analysis was performed using Mann-Whitney U test and Kruskal-Wallis test and a logistic regression. Results: Elevated serum CA-125 levels were significantly correlated with advanced-stage disease, lymph node metastases, increased depth of myometrial invasion (P < 0,01). Similar correlation was seen between levels of CA-125 and positive peritoneal washing cytology, distant metastases and highest histologic grade. Multivariate analyses using logistic regression showed that lymph node metastases had the most significant effect on the elevation of preoperative serum CA-125 levels. Conclusion: The preoperative serum CA-125 level appears to be a significant independent predictor of advanced-stage disease and lymph node metastasis. Therefore, preoperative serum CA-125 may be a useful tool, in the clinical setting, for optimal individualized patient management. A CA-125 level should be included as a part of the preoperative workup for all patients with endometrial cancer. Preoperative serum CA-125 may be a useful tool, in the preoperative workup for all patients with endometrial cancer.

Transtubal Transport of Carcinoma Cells Into the Peritoneal Cavity After Saline Infusion via Transcervical Route in Patients With Endometrial Carcinoma

The aim of this study was to evaluate the rate of transtubal passage of carcinoma cells into the abdominal cavity after saline infusion in patients with endometrial carcinoma. Forty-four patients with primary endometrial carcinoma, who had been planned to be operated on, were included into this study. A pediatric foley catheter was inserted into the endometrial cavity via cervical route just before laparotomy. During laparotomy, fallopian tubes, on both sides, were inserted into 2 separate plastic bags. A maximum of 150 mL (range, 20-150 mL) of saline was infused into the endometrial cavity via foley catheter by a syringe. Fluid running off through the fallopian tubes was collected separately. Transtubal fluid passage was detected in 24 (54.5%) of 44 patients. In all patients without tubal passage, the initial results of peritoneal washing cytology were negative. On the other hand, the initial (in vivo) results of peritoneal cytology were positive in 2 of 24 patients in whom transtubal saline transport was detected. After the procedure, in 6 (25%) of 24 patients with transtubal passage, cytological examination revealed malignant cells in the collected fluid through the tubes. In all patients, in whom transtubal passage was not observed, tumor localization was fundal. However, in 6 of 24 patients with transtubal passage, there were different locations. We suggest that saline infusion sonohysterography can cause dissemination of malignant cells into the abdominal cavity.