The Role of Liquid Based Cytology and Ancillary Techniques in the Peritoneal Washing Analysis: Our Institutional Experience

Esther Rossi, Tommaso Bizzarro, Maurizio Martini, Adhemar Longatto-Filho, Fernando Schmitt, Anna Fagotti, Giovanni Scambia, Gian Franco Zannoni, Esther Rossi, Tommaso Bizzarro, Maurizio Martini, Adhemar Longatto-Filho, Fernando Schmitt, Anna Fagotti, Giovanni Scambia, Gian Franco Zannoni

Abstract

Background: The cytological analysis of peritoneal effusions serves as a diagnostic and prognostic aid for either primary or metastatic diseases. Among the different cytological preparations, liquid based cytology (LBC) represents a feasible and reliable method ensuring also the application of ancillary techniques (i.e immunocytochemistry-ICC and molecular testing).

Methods: We recorded 10348 LBC peritoneal effusions between January 2000 and December 2014. They were classified as non-diagnostic (ND), negative for malignancy-NM, atypical-suspicious for malignancy-SM and positive for malignancy-PM.

Results: The cytological diagnosis included 218 ND, 9.035 NM, 213 SM and 882 PM. A total of 8048 (7228 NM, 115SM, 705 PM) cases with histological follow-up were included. Our NM included 21 malignant and 7207 benign histological diagnoses. Our 820 SMs+PMs were diagnosed as 107 unknown malignancies (30SM and 77PM), 691 metastatic lesions (81SM and 610PM), 9 lymphomas (2SM and 7PM), 9 mesotheliomas (1SM and 8SM), 4 sarcomas (1SM and 3PM). Primary gynecological cancers contributed with 64% of the cases. We documented 97.4% sensitivity, 99.9% specificity, 98% diagnostic accuracy, 99.7% negative predictive value (NPV) and 99.7% positive predictive value (PPV). Furthermore, the morphological diagnoses were supported by either 173 conclusive ICC results or 50 molecular analyses. Specifically the molecular testing was performed for the EGFR and KRAS mutational analysis based on the previous or contemporary diagnoses of Non Small Cell Lung Cancer (NSCLC) and colon carcinomas. We identified 10 EGFR in NSCCL and 7 KRAS mutations on LBC stored material.

Conclusions: Peritoneal cytology is an adjunctive tool in the surgical management of tumors mostly gynecological cancers. LBC maximizes the application of ancillary techniques such as ICC and molecular analysis with feasible diagnostic and predictive yields also in controversial cases.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Diagram summarizing the data concerning…
Fig 1. Diagram summarizing the data concerning Suspicious for malignancy (SM) plus Positive for malignancy (PM) peritoneal cases.
Fig 2. a) Details of a malignant…
Fig 2. a) Details of a malignant peritoneal effusion from an ovarian carcinoma showing a papillary architecture of a neoplastic cellular cluster (PAPx400, LBC); b) Positivity for CA125 in the same Fig 1 (peritoneal effusion from an ovarian carcinoma) on LBC (avidin-biotin-peroxidase complex x400, LBC).
Fig 3. a) Details of a malignant…
Fig 3. a) Details of a malignant peritoneal effusion from a metastatic melanoma showing the pleomorphic features and pigment (PAPx400, LBC); b) Positivity for S100 in the same case (peritoneal effusion from a metastatic melanoma) on LBC (avidin-biotin-peroxidase-ABC complex x400, LBC); c) positivity for Melan A in the same case (ABC complex x400, LBC).

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