Kang So Hyun, Na Hee Young, Choi Younghwa, Lee Eunju, Yoo Mira, Hwang Duyeong, Min Sa-Hong, Park Young Suk, Ahn Sang-Hoon, Suh Yun-Suhk, Park Do Joong, Lee Hye Seung, Kim Hyung-Ho
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.
J Gastric Cancer. 2023 Oct;23(4):549-560. doi: 10.5230/jgc.2023.23.e34.
According to the American Joint Committee on Cancer cancer staging system, positive peritoneal washing cytology (PWC) indicates stage IV gastric cancer. However, rapid intraoperative diagnosis of PWC has no established reliable method. This study evaluated and compared the diagnostic accuracy of the Shorr and the modified ultrafast Papanicolaou (MUFP) methods for intraoperative PWC.
This study included patients with gastric cancer who were clinically diagnosed with stage cT3 or higher. The Shorr and MUFP methods were performed on all PWC specimens, and the results were compared with those of conventional Papanicolaou (PAP) staining with carcinoembryonic antigen immunohistochemistry. Sensitivity, specificity, and partial likelihood tests were used to compare the 2 methods.
Forty patients underwent intraoperative PWC between November 2019 and August 2021. The average time between specimen reception and slide preparation using Shorr and MUFP methods was 44.4±4.5 minutes, and the average time between specimen reception and pathologic diagnosis was 53.9±8.9 minutes. Eight patients (20.0%) had positive cytology in PAP staining. The Shorr method had a sensitivity of 75.0% and specificity of 93.8%; the MUFP method had 62.5% sensitivity and 100.0% specificity. The area under the curve was 0.844 for Shorr and 0.813 for MUFP. In comparing the C-indices of each method with overall survival, no difference was found among the Shorr, MUFP, and conventional PAP methods.
The Shorr and MUFP methods are acceptable for the intraoperative diagnosis of PWC in advanced gastric cancer.
根据美国癌症联合委员会的癌症分期系统，阳性腹膜冲洗细胞学检查（PWC）提示为IV期胃癌。然而，术中快速诊断PWC尚无成熟可靠的方法。本研究评估并比较了Shorr法和改良超快速巴氏（MUFP）法对术中PWC的诊断准确性。
本研究纳入临床诊断为cT3期或更高分期的胃癌患者。对所有PWC标本采用Shorr法和MUFP法进行检测，并将结果与癌胚抗原免疫组化的传统巴氏（PAP）染色结果进行比较。采用敏感性、特异性和部分似然比检验来比较这两种方法。
2019年11月至2021年8月期间，40例患者接受了术中PWC检查。使用Shorr法和MUFP法从接收标本到制备玻片的平均时间为44.4±4.5分钟，从接收标本到病理诊断的平均时间为53.9±8.9分钟。8例患者（20.0%）PAP染色细胞学检查呈阳性。Shorr法的敏感性为75.0%，特异性为93.8%；MUFP法的敏感性为62.5%，特异性为100.0%。Shorr法的曲线下面积为0.844，MUFP法为0.813。比较各方法的C指数与总生存率，Shorr法、MUFP法和传统PAP法之间未发现差异。
Shorr法和MUFP法可用于进展期胃癌术中PWC的诊断。
