Ascites in Ovarian Carcinoma – Reliability and Limitations of Cytological Analysis

Liu

J of Obstet and Gynaecol

et al. 2018

Section: Discussionmentioning

confidence: 99%

Potential risk factors associated with prognosis of neoadjuvant chemotherapy followed by interval debulking surgery in stage IIIc–IV high‐grade serous ovarian carcinoma patients

Liu

J of Obstet and Gynaecol

et al. 2018

“…Precise cytological diagnosis of pelvic HGSC from ascites is important for tumour staging and therapeutic decision‐making , especially for patients who need accurate tumour typing by preoperative ascites cytology before receiving neoadjuvant chemotherapy. However, based on published studies, the sensitivity of peritoneal cytology ranges from 50%‐70% . Zivadinovic et al showed that the false‐negativity in ascites cytology for ovarian carcinoma was 30.2%, whereas the false‐positivity was 6.38% for all histological types of malignant ovarian tumours.…”

Section: Discussionmentioning

confidence: 99%

“…The primary cytology of ascites is an important for diagnosis, therapeutic decision and prognostic prediction. The results of secondary cytology after treatment are also important independent prognostic indicators that are highly correlated with optimal surgery outcomes, recurrence and overall survival rate . However, an increasing number of studies have shown that the morphological examination of cytological samples is not a highly sensitive diagnostic tool to distinguish metastatic adenocarcinoma from reactive mesothelial cells in ascites.…”

Section: Introductionmentioning

confidence: 99%

Improving the cytological diagnosis of high‐grade serous carcinoma in ascites with a panel of complementary biomarkers in cell blocks

et al. 2017

Introduction Precise cytological diagnosis of pelvic high‐grade serous carcinoma (HGSC) in ascites is important for tumour staging, therapeutic decision‐making and prognostic evaluation. However, it can often be difficult to distinguish metastatic HGSC cells from reactive mesothelial cells based on morphology alone. Immunocytochemical analysis of ascites cell blocks has been used to obtain accurate diagnosis and provide a reliable basis for treatment decisions in the clinic. This study was performed to determine whether a panel of antibodies is necessary to achieve high specificity and sensitivity for the identification of HGSC cells. Methods Ascites samples from 70 cases (70/253, 27.7%) of histologically confirmed HGSC were postoperatively collected from 2012 to 2015 and were immunocytochemically analysed. Results The sensitivity and specificity of Ber‐EP4 (a marker of HGSC) for detecting HGSC was 85.7% and 82.1%, respectively, whereas the sensitivity and specificity of HBME‐1 for identifying mesothelial cells was 100% and 68.3%, respectively. To improve the rate of detection further of HGSC, 29 cases of ascites were also stained for E‐cadherin (a marker of HGSC) and calretinin (a marker of mesothelial cells). The combination of Ber‐EP4 and E‐cadherin as markers of adenocarcinoma cells increased the sensitivity and specificity for HGSC detection to 100% and 88.9%, respectively. Meanwhile, the sensitivity and specificity for mesothelial cell identification increased to 100% and 90%, respectively, when HBME‐1 and calretinin were combined. Conclusion This panel of complementary biomarkers is valuable and ideal for the differential diagnosis of HGSC based on ascites cytology.

Ascites - Physiopathology, Treatment, Complications and Prognosis

“…In that study, it was concluded that peritoneal cytology of ascitic fluid is highly specific (93.61%) but it has a relatively low sensitivity (68.92%). In 30.02%, peritoneal cytology had false-negative results, and in 6.38%, it showed false-positive results [11].…”

Section: Cytology Biochemistry and Immunohistochemistry Of Ascitic mentioning

confidence: 99%

Ascitic Fluid in Ovarian Carcinoma – From Pathophysiology to the Treatment

Živadinović¹,

Petrić²,

Krtinić³

et al. 2017

Due to low symptomatology, a lack of screening, and relatively complicated diagnostic procedures of ovarian carcinoma, more and more women are believed to visit their doctors in advanced stage of the disease, complicated with ascitic fluid. There is an increasing evidence that peritoneal cytology is a subjective assessment with certain percentage of false-positive and false-negative results that may cause application of unnecessary chemotherapy or nonapplication of necessary chemotherapy. Maximal cytoreductive surgery followed by intraperitoneal or systemic chemotherapy remains to be the gold standard in preventing ascites. Ascites is not only a symptom of a disease, but a specific microenvironment for formation and mediation of protumorigenic signals that control ovarian cancer progression, proliferation, invasion, anti-apoptosis, chemoresistance and tumor heterogeneity. Acellular cytokines and immunological factors influence ovarian cancer progression and its ability to prevent immune responses of the body and tumor reaction to chemotherapy. Ascites contributes to disease dissemination, changing its course and final outcomes. Management of patients with ascites and ovarian carcinoma is complex and often the goal of the treatment is to target palliative procedures. Multidisciplinary approach is necessary in the management of these patients. Further investigations of new drugs and immunomodulators are needed aiming at prolonged periods between relapses.