Diagnostic accuracy of peritoneal fluid lavage cytology in detection of peritoneal seeding in patients with gastric adenocarcinoma

Abstract

Background: Peritoneal cytology has received little attention in the literature, but it may be an additional useful means in evaluating patients with primary gastric cancer. The aim of this study was to examine the diagnostic accuracy of peritoneal fluid lavage cytology in detecting peritoneal seeding in patients with gastric adenocarcinoma. Methods: A total of 50 patients with gastric adenocarcinoma who were candidates for laparotomy based on the findings of computed tomographic examination were recruited. Diagnostic peritoneal lavage (DPL) was performed just before laparotomy and the peritoneal lavage fluid was sent for cytological examination for presence or absence of malignant cells. Findings in terms of peritoneal involvement during laparotomy were regarded as the standard results. Results: DPL cytology was positive for the presence of malignant cells in the peritoneal fluid in 25 cases (50%). According to the intraoperative findings 22 patients (44%) had peritoneal metastatic disease, whereas in 28 patients (56%) no gross indicator of metastasis was detected. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of cytology in detecting peritoneal seeding were 59%, 57%, 52%, 64%, 1.38 and 1.40, respectively. The agreement between cytology and diagnostic laparotomy was 58%. Conclusion: According to the findings of the present study peritoneal lavage solely is not a proper diagnostic method for early recognition of resectable/nonresectable gastric cancers.