Study of ascitic fluid cytology in ovarian tumors
Keywords:Ascites, Ovarian carcinoma, Peritoneal fluid cytology
Background: The objectives of this study were to examine the validity of ascitic fluid cytology in the detection of pathological findings, to examine the percentage of false positive and false negative results in the cytology of ascitic fluid and to determine the validity of peritoneal cytology in relation to the histopathological type of the ovarian tumour.
Methods: This retrospective study, over a period of 6 months, included 106 peritoneal cytology findings. The experimental group included 106 cytology findings obtained from patients who presented with an abdominal lump/mass with ascites and diagnosed with ovarian tumors clinically. They included 88 benign ovarian tumours (83%) and 18 malignant ovarian tumors (17%). Patients with other causes of ascites were excluded from the study.
Results: The sensitivity of peritoneal cytology is 90%, specificity is 96.5%, positive predictive value is 85.7%, and negative predictive value is 97.6%. In 1.8% of patients, the peritoneal cytology showed false negative results, while in 2.8%, the results were false positive. False negative results were found in one case of teratoma with squamous cell carcinoma and one case of yolk sac tumor. False positive results were found in 2 cases of tuberculous-salpingo- oophoritis and one case of chronic salpingo-oophoritis due to reactive mesothelial proliferation, mistaken for adenocarcinoma.
Conclusions: Peritoneal cytology of ascitic fluid is highly specific and sensitive for detection of ovarian malignancies, particularly in grade 3 and grade 4 disease, since most of the patients with ovarian malignancies present to us at advanced stage of the disease.
Runyon BA. Care of patients with ascites. N Engl J Med. 1994;330:337-42.
Suma L, Thomas J. Malignant ascites: a review of prognostic factors, pathophysiology and therapeutic measures. World J Gastrointest Surg. 2012;4:87-95.
Becker G, Galandi D, Blum HE. Malignant ascites: systematic review and guideline for treatment. Eur J Cancer. 2006;42:589-97.
Stanojevic Z, Rancic G, Radic S, Potic-Zecevic N, Djordjevic B, Markovic M, et al. Pathogenesis of malignant ascites in ovarian cancer patients. Arch Oncol. 2004;12:115-8.
Garrison RN, Kaelin LD, Galloway RH, Heuser LS. Malignant ascites. Clinical and experimental observations. Ann Surg. 1986;203:644-751.
Shen-Gunther J, Mannel RS. Ascites as a predictor of ovarian malignancy Gynecol Oncol. 2002;87:77-83.
Oscar L. Challenges in the interpretation of peritoneal cytologic specimens. Arch Pathol Lab Med. 2009;133:739-42.
Runyon BA, Hoefs JC, Morgan TR. Ascitic fluid analysis in malignancy-related ascites. Hepatology. 1988;8:1104-9.
Karoo R, Garccea G. How valuable is ascitic cytology in the detection and management of malinancy. Postgrad Med J. 2003;79:292-4.
Zuna RE, Behrens AJ. Peritoneal washing cytology in gynecologic cancers: long-term follow-up of 355 patients. ActaCytol. 1996;88:980-7.
Cheng L, Wolf NG, Rose PG, Rodriguez M, Abdul-Karim FW. Peritoneal washing cytology of ovarian tumors of low malignant potential: correlation with surface ovarian involvement and peritoneal implants. Acta Cytol. 1998;42:1091-4.
Sirop S, Kanaan M, Wiese D, Dutt N, Karla V, Singh TT, et al. A second peritoneal cytology as a prognostic factor in epithelial ovarian cancer. J Clin Oncol. 2011;29(15_suppl):e15558.