Peritoneal lavage cytology and carcinoembryonic antigen determination in predicting peritoneal metastasis and prognosis of gastric cancer

Abstract

AIM:To evaluate the role of peritoneal lavage cytology (PLC) and carcinoembryonic antigen (CEA) determination of peritoneal washes (pCEA) in predicting the peritoneal metastasis and prognosis after curative resection of gastric cancer. METHODS:PLC and radioimmunoassay of CEA were performed in peritoneal washes from 64 patients with gastric cancer and 8 patients with benign diseases. RESULTS:The positive rate of pCEA (40.6%) was significantly higher than that of PLC (23.4%) (P <0.05). The positive rates of PLC and pCEA correlated with the depth of tumor invasion and lymph node metastasis (P <0.05). pCEA was found to have a higher sensitivity and a lower false-positive rate in predicting peritoneal metastasis after curative resection of gastric cancer as compared to PLC. The 1-, 3-, and 5-year survival rates of patients with positive cytologic findings or positive pCEA results were significantly lower than those of patients with negative cytologic findings or negative pCEA results (P <0.05). Multivariate analysis indicated that pCEA was an independent prognostic factor for the survival of patients with gastric cancer. CONCLUSION:Intraoperative pCEA is a more sensitive and reliable predictor of peritoneal metastasis as well as prognosis in patients with gastric cancer as compared to PLC method.

Prognostic significance of peritoneal washing cytology in Thai patients with gastric adenocarcinoma undergoing curative D2 gastrectomy

“…The specificity and positive predictive value of PWC in predicting peritoneal recurrence was high (100%), but the sensitivity was only 61%. The sensitivity of PWC was also relatively low in previous reports, ranging from 14% to 70% [1,3,5,14,26]. The relatively high false-negative rate might imply technical flaws such as incomplete sampling in the lavage process.…”

“…Peritoneal recurrence is a common cause of death even after curative resection for gastric adenocarcinoma [1][2][3][4][5][6]. This is believed to be due to the presence of malignant cells that have already seeded at the time of operation but cannot be detected macroscopically.…”

A systematic review of the accuracy and utility of peritoneal cytology in patients with gastric cancer

“…Of the 17 articles where conventional cytology was used to detect IFCCs, 11 commented on the risk of peritoneal recurrence [23,24,30,31,33,41,42,[44][45][46][47]. Table 1 summarizes the results, with conventional cytology predicting peritoneal recurrence with an accuracy of 73-91.9%, sensitivity of 11.1-80%, and specificity of 86.4-100%.…”

“…Four of the six articles using immunoassay to detect IFCCs commented on peritoneal recurrence [33,43,45,46]. Based on these articles, the accuracy, sensitivity, and specificity of immunoassay in predicting peritoneal recurrence was 72-95, 23-100, and 81-92.9%, respectively ( Table 2).…”

“…IFCCs were identified by conventional cytology in 17 articles [21, 23, 24, 30-35, 39, 41, 42, 44-48], immunoassay in 6 articles [26,33,35,43,45,46], IHC in 4 articles [22,37,40,44], and RT-PCR in 14 articles [24, 25, 27-30, 35, 36, 38, 41, 42, 45-47]. Further details of the specific analyses can be viewed in Appendix B in the ESM.…”