Zhang Xinming, Liu Xin, Sun Fengbo, Li Shouchuan, Gao Wei, Wang Ye
1 Department of General Surgery, Qingdao Hiser Medical Center , Qingdao, China .
2 Department of Health Care, The Third People's Hospital of Qingdao , Qingdao, China .
J Laparoendosc Adv Surg Tech A. 2017 Feb;27(2):106-109. doi: 10.1089/lap.2016.0295. Epub 2016 Sep 8.
To evaluate the diagnostic value of cytological greater omental milky spot examination for the diagnosis of peritoneal metastasis in gastric cancer patients.
A total of 136 patients diagnosed with gastric cancer and without distant metastasis were enrolled in our study. All patients underwent laparoscopy and CH40 suspension liquid dye of peritoneal lymph nodes preoperatively as well as ascites or peritoneal lavage fluid collections and excisions of marked greater omental milky spot tissues perioperatively.
According to the laparoscopic results, the patients were divided into T1-T2 stage (n = 56) without and into T3-T4 stage (n = 80) with tumor invasion into the serosal layer. Among the T1-T2-stage patients, tumor cells could be detected in peritoneal lavage fluids in 2 cases, whereas with greater omental milky spot examination, peritoneal metastasis was detected in 8 cases. Among the 80 cases in the T3-T4 stage, tumor cells could be detected in 28 cases via peritoneal lavage cytology and in 43 cases by greater omental milky spot examinations, and 4 cases had cancer cell infiltration also in nonmilky spot omental areas. The statistical analysis showed that the staging accuracy rate of exfoliative cytology examination was superior to that of the laparoscopic exploration (P < .05), but its sensitivity was significantly lower than that obtained with cytological greater omental milky spot examinations (P < .05).
The laparoscopic exploration could make a preliminary diagnosis of peritoneal metastasis via serosal layer invasion detection. For further analyses, cytological examinations of greater omental milky spots were more sensitive than exfoliative cytology.
评估细胞学大网膜乳斑检查对胃癌患者腹膜转移诊断的价值。
本研究共纳入136例确诊为胃癌且无远处转移的患者。所有患者术前均接受腹腔镜检查及腹腔淋巴结CH40悬浮液染色，术中收集腹水或腹腔灌洗液，并切除标记的大网膜乳斑组织。
根据腹腔镜检查结果，患者分为未侵犯浆膜层的T1 - T2期（n = 56）和侵犯浆膜层的T3 - T4期（n = 80）。在T1 - T2期患者中，腹腔灌洗液中检测到肿瘤细胞2例，而大网膜乳斑检查发现腹膜转移8例。在T3 - T4期的80例患者中，腹腔灌洗细胞学检查检测到肿瘤细胞28例，大网膜乳斑检查检测到43例，4例在非乳斑大网膜区域也有癌细胞浸润。统计学分析表明，脱落细胞学检查的分期准确率优于腹腔镜探查（P <.05），但其敏感性显著低于大网膜乳斑细胞学检查（P <.05）。
腹腔镜探查可通过检测浆膜层侵犯对腹膜转移做出初步诊断。进一步分析时，大网膜乳斑细胞学检查比脱落细胞学更敏感。
