The impact of peritoneal lavage cytology in biliary tract cancer (KHBO1701): Kansai Hepato‐Biliary Oncology Group

Abstract

Background Only few studies in literature have analyzed the clinical effects of peritoneal lavage status in biliary tract cancers. Aim We aimed to assess the effect of cytology‐positive peritoneal lavage on survival for patients with biliary tract cancer who underwent curative resection. Methods The KHBO1701 study was a multi‐institutional retrospective study that assessed the clinical effects of peritoneal lavage cytology in biliary tract cancers. Using clinicopathological data from 11 Japanese institutions, we compared long‐term outcomes between patients with cytology‐positive and cytology‐negative peritoneal lavage. Results Of 169 patients who underwent curative resection, 164 were cytology‐negative, and five were cytology‐positive. The incidence of portal invasion and preoperative carbohydrate antigen 19‐9 levels were higher in the cytology‐positive group than in the cytology‐negative group. The incidence of peritoneal metastatic recurrence was also higher, and overall survival tended to be worse in the cytology‐positive group. In contrast, recurrence‐free survival was similar between the cytology‐negative and cytology‐positive groups. Conclusions The positive status of peritoneal lavage cytology could moderately affect the survival of patients with biliary tract cancers. Given that surgical resection is the only curative treatment option, it may be acceptable to resect biliary tract cancers without other non‐curative factors, regardless of peritoneal lavage cytology status.

Conversion surgery following gemcitabine plus cisplatin therapy for initially unresectable gallbladder cancer with peritoneal carcinomatosis: a case report

“…Peritoneal lavage cytology gave positive findings, but we were still able to achieve macroscopic resection and long-term survival. A recent report suggested that it may be acceptable to resect BTC without other non-curative factors, regardless of the peritoneal lavage cytology status [15], and this supports our treatment strategy for this patient. All of the above suggests that surgical macroscopic radical resection is highly conducive to positive patient outcomes.…”

LC‐1000 flow cytometry system complements intraoperative peritoneal cytology for pancreatic and biliary tract cancer

“…If sufficient ascites was present at the time of laparotomy, the ascites was collected for cytology testing. When patients had no ascites, the pelvic and/or subhepatic space was washed with 0.9% sodium chloride (50-100 mL) after laparotomy, 6,10 of which approximately 10 mL of peritoneal lavage fluid was collected. Specimens were evaluated according to the Papanicolaou classification as follows: Class I, absence of atypical cells or abnormal cells; Class II, atypical cytology but no evidence of malignancy; Class III, cytology suggestive of, but not conclusive for, malignancy; Class IV, cytology strongly suggestive of malignancy; Class V, cytology conclusive for malignancy.…”

“…CY+ is widely known to be a prognostic factor for gastric cancer, 18 and in patients with gastric cancer, CY+ is diagnosed as distant metastasis. In contrast, the association between CY+ and prognosis for PC [1][2][3][4][5][6][7][8] and BTC [9][10][11] is controversial. For PC, cytology has recently been considered one of the factors that should be evaluated for tumor staging; and CY+ has been defined as M1 by the American Joint Committee on Cancer (AJCC), 19 the TNM staging system of the Union for International Cancer Control (UICC), 15 and the National Comprehensive Cancer Network (NCCN) guidelines.…”

“…Furthermore, for BTC, few studies have been conducted on the prognostic impact of CY+. [9][10][11] There are several problems with cytology testing. First, the results depend on the skill and subjectivity of the pathologist.…”

“…Intraoperative peritoneal cytology can detect malignant cells by microscopy inspection of Papanicolaou‐stained specimens of ascites or peritoneal lavage fluid extracted after laparotomy. The proportion of positive cytology (CY+) has been reported to be 5.4%–30% for pancreatic cancer (PC) 1–8 and 3.0%–9.8% for biliary tract cancer (BTC) 9–11 . However, in conventional diagnosis based on cytomorphology, there were not a few cases unavoidably diagnosed as “suspicious” because of the confounding effects of degenerated cells and reactive mesothelial cells that are difficult to distinguish from malignant cells, or because of the small number of cells that could be judged as malignant.…”