A systematic review of the accuracy and utility of peritoneal cytology in patients with gastric cancer

Abstract

Background There is lack of uniformity in the utilization of peritoneal cytology in gastric cancer management. The identification of intraperitoneal free cancer cells (IFCCs) is believed to confer poor prognosis. However, while some of these patients are palliated, others may undergo more aggressive therapies. In this review, we aimed to identify and synthesize findings on the use of peritoneal cytology in predicting peritoneal recurrence and overall survival in curative gastric cancer patients. Methods Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 31, 2009. We determined the accuracy, sensitivity, and specificity of peritoneal cytology in predicting peritoneal recurrence based on four techniques-conventional cytology, immunoassay, immunohistochemistry, and reverse transcriptase-polymerase chain reaction. Recurrence rates and overall survival rates for curative patients were determined, based on positivity or negativity for IFCCs. Results Twenty-eight articles were included. All four techniques showed wide variations in accuracy, sensitivity, and specificity in predicting peritoneal recurrence. Recurrence rates for patients positive for IFCCs ranged from 11.1 to 100%, while those negative for IFCCs had recurrence rates of 0-51%. Overall survival was significantly reduced for patients with positive IFCCs. Short follow-up periods and possible duplication of results may limit result interpretation. Conclusion The presence of IFCCs appears to increase the risk of peritoneal recurrence and is associated with worse overall survival in gastric cancer patients. Further incorporation of peritoneal cytology in clinical decisionmaking in gastric cancer depends on the development of a consistently accurate and rapid IFCC detection method.

A systematic review and meta-analysis of gastric cancer treatment in patients with positive peritoneal cytology

“…The use of RT-PCR to detect micrometastatic disease is currently not widely accepted because of its variation in technique, the choice of detection of different tumor-derived antigens, and the possibility of false-positive results. In fact, a recent systematic review incorporating a number of studies that examined the utility of RT-PCR showed wide confidence intervals in diagnostic performance, including an accuracy of 61-89.7 %, sensitivity of 31-100 %, and specificity of 58.8-95 % [2].…”

“…Endoscopic ultrasound (EUS) is used selectively in patients with early-stage tumors to determine if endoscopic resection is feasible or whether neoadjuvant therapy is warranted. Laparoscopy and peritoneal cytology have been shown to detect occult metastatic disease not seen on conventional imaging [1][2][3][4].…”

“…Those with only microscopic metastatic peritoneal disease, detected by the presence of malignant cells in peritoneal washout, also have dismal long-term outcomes, with 5-year survival rates ranging from 0 % to 18 %, with the majority succumbing to peritoneal recurrence within 2 years [2].…”

“…The aim of this systematic review is to investigate the following four modalities of treatment (and their possible additional benefit to standard treatment) as well as their role in the management of patients with PPC-only disease: (1) extensive intraperitoneal lavage (EIPL); (2) intraoperative intraperitoneal chemotherapy (IIPC); (3) oral S-1 chemotherapy; and (4) neoadjuvant chemotherapy with curative resection.…”

Prognostic Role of Gastrectomy in Patients With Gastric Cancer With Positive Peritoneal Cytology

“…2,3 Patients with cancer cells in the peri-toneal cavity (peritoneal cytology positive; CY1) could constitute such a population. A CY1 status is a predictor of peritoneal dissemination 4 and a poor prognostic factor in patients with gastric cancer. [5][6][7][8] However, the recent introduction of chemotherapy has changed the clinical picture to some extent.…”