Özkara Sevgiye Kaçar
Department of Pathology, Kocaeli University Medical Faculty, Kocaeli, Turkey.
Acta Cytol. 2011;55(1):57-68. doi: 10.1159/000320858. Epub 2010 Nov 26.
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.
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.
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.
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.
作者评估了在附件包块评估中连续进行的一组腹膜冲洗液（PW）检查，以确定传统组织病理学预后参数是否会显著影响该检查的肿瘤检出率。
回顾了1996年至2008年13年间在评估恶性和交界性卵巢肿瘤时进行的所有PW的细胞病理学报告，并将其与同步获取的组织病理学标本的报告进行关联。将低恶性潜能（LMP）肿瘤分开进行分析。采用χ2检验确定统计学意义。
在该研究中，共有134例PW与累及卵巢的原发性上皮性恶性肿瘤（n = 114）或LMP肿瘤（n = 20）相关。透明细胞癌（83.3%）、未分化癌（80.0%）和浆液性癌（65.7%）的PW细胞病理学阳性率高于所有组织病理学亚型的总体平均阳性率（62.3%）。相比之下，子宫内膜样癌（41.2%）和黏液性癌（45.5%）的细胞病理学阳性率明显低于总体平均阳性率（p = 0.118）。正如预期的那样，与低级别（I级，38.7%）和低分期（I + II期）肿瘤（32.4%）相比，高级别（II + III级，71.1%，p = 0.002）和高分期（III + IV期）肿瘤（76.6%，p = 0.000）的PW更有可能检出恶性细胞，有淋巴结受累的肿瘤（72.7%，p = 0.021）比无淋巴结受累的肿瘤（46.7%）以及双侧肿瘤（74.6%，p = 0.004）比单侧肿瘤（42.9%）的PW更易检出恶性细胞。具有明显多形性（81.0%）、高有丝分裂评分（80.0%）和实性结构（72.9%，p = 0.122）的相应原发性卵巢癌的PW细胞病理学阳性率也高于总体平均阳性率。卵巢癌（n = 114）病例的总体敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和效率分别为72.3%、85%、95.8%、39.5%和74.6%。LMP浆液性肿瘤的PW细胞病理学阳性率（7.1%）高于LMP黏液性肿瘤（0.0%）以及LMP卵巢肿瘤的总体平均细胞病理学阳性率（5.0%）。LMP肿瘤的计算敏感性、特异性、PPV、NPV和效率分别为33.3%、100%、100%、89.5%和90%。
PW细胞病理学结果与几乎所有传统组织病理学预后参数以及相应原发性卵巢癌的细胞 - 组织形态学参数显著相关。细胞病理学阳性率也因组织病理学亚型而异。假阴性和“假阳性”与肿瘤分级显著相关。
