Significance of Peritoneal Washing Cytopathology in Ovarian Carcinomas and Tumors of Low Malignant Potential: A Quality Control Study with Literature Review

Abstract

Objective: The author evaluated a consecutive group of peritoneal washings (PWs) performed in the evaluation of adnexal masses to determine whether the conventional histopathologic prognostic parameters significantly affect the tumor detection rate using this procedure. Study Design: Cytopathologic reports from all PWs performed over a 13-year (1996–2008) period in the evaluation of malignant and borderline ovarian tumors were reviewed and correlated with those of the synchronously obtained histopathologic specimens. Tumors of low malignant potential (LMP) were separated for analysis. Statistical significance was determined using the χ² test. Results: In the study, a total of 134 PWs were associated with primary epithelial malignant tumors (n = 114) or tumors of LMP (n = 20) involving the ovary. The positive PW cytopathology rates for clear cell (83.3%), undifferentiated (80.0%), and serous carcinomas (65.7%) were higher than the overall average positive rate (62.3%) for all histopathologic subtypes. In contrast, endometrioid (41.2%) and mucinous (45.5%) carcinomas had markedly lower cytopathology-positive rates than the overall average positive rate (p = 0.118). As expected, PWs were found to be significantly more likely to yield malignant cells in higher-grade (grades II + III, 71.1%, p = 0.002) and higher-stage (stages III + IV) tumors (76.6%, p = 0.000) than in lower-grade (grade I, 38.7%) and lower-stage (stages I + II) tumors (32.4%) and also in tumors with lymph node involvement (72.7%, p = 0.021) than in tumors without lymph node involvement (46.7%) and in bilateral tumors (74.6%, p = 0.004) than in unilateral tumors (42.9%). The positive cytopathology rates for the PWs of the corresponding primary ovarian carcinomas with prominent pleomorphism (81.0%, p = 0.007), with high mitotic score (80.0%, p = 0.006) and solid architecture (72.9%, p = 0.122) were also higher than the overall average positive rate. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and efficiency for the ovarian carcinoma (n = 114) cases were 72.3, 85, 95.8, 39.5 and 74.6%, respectively. The positive cytopathology rate for the PWs of the serous tumors of LMP (7.1%) was higher than that of the mucinous tumors of LMP (0.0%) and the overall average positive cytopathology rate (5.0%) for the ovarian tumors with LMP. The calculated sensitivity, specificity, PPV, NPV, and efficiency for tumors of LMP were 33.3, 100, 100, 89.5, and 90%, respectively. Conclusion: PW cytopathology results correlate significantly with almost all of the conventional histopathologic prognostic parameters and the cyto-histomorphologic parameters of the corresponding primary ovarian carcinomas. The positive cytopathology rates also differ according to the histopathologic subtypes. False negativity and ‘false positivity?’ was significantly correlated with tumor grade.

Advanced stage micropapillary serous borderline ovarian tumor in a postmenopausal woman: a case report

“…Our case presented as stage III-B disease. Positive peritoneal cytology rates increase with advancing tumor stage (7). In our case, cytology was also positive.…”

Role of peritoneal washing cytology in ovarian malignancies: correlation with histopathological parameters

“…Fifteen (33 %) of high-grade tumors showed negative histology. Ozkara reported that PW were significantly more likely to yield malignant cells in higher grade than lower grade tumors [ 13 ].…”

Peritoneal washing cytology in an adult granulosa cell tumor: A case report and review of literature

“…Exfoliation of tumor cells in peritoneal washing samples raises the FIGO stage from IA/IB or IIA/IIB to stage IC or IIC despite the absence of a grossly visible tumor. [1] However, stage is the most important prognostic factor for AGCT. [5] Sun et al .…”

“…[1] However, while it is important for tumor staging, it is very difficult to identify the presence of rare tumor cells and to diagnose AGCT using peritoneal washing. Cytological examination of tumor cells has mostly focused on samples obtained using fine-needle aspiration and ascitic fluids.…”