Gastric cancer cell detection in peritoneal washing: cytology versus RT-PCR for CEA transcripts.

Department of Anatomical & Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
Diagnostic Molecular Pathology (Impact Factor: 2.28). 06/2003; 12(2):88-95. DOI: 10.1097/00019606-200306000-00004
Source: PubMed

ABSTRACT This study investigates the sensitivity and specificity of cytology, qualitative, and real-time RT-PCR methods in free cancer cell detection of peritoneal washing from gastric cancer patients. Peritoneal washings were collected from 65 gastric cancer patients for routine cytology and total RNA extraction for qualitative and real-time RT-PCR for CEA. The sensitivity and false-positive rate was 51.1%, 0% for cytology, 48.9% and 5% for qualitative RT-PCR for CEA, and 42.5% and 5% for real-time RT-PCR for CEA. The qualitative and real time RT-PCR results show high concordance rate (89.7%). The highest sensitivity was obtained by the combination of cytology with qualitative RT-PCR for CEA (70.2%). RT-PCR results were positive in 63.6% of cytologic "atypia" cases. Combination of cytology and either of the RT-PCR methods resulted in significantly higher sensitivity than any one of the three methods alone (P < 0.05). There was no definite advantage of the real-time RT-PCR over the conventional RT-PCR.

  • [Show abstract] [Hide abstract]
    ABSTRACT: A meta-analysis was performed to assess the diagnostic values of carcinoembryonic antigen (CEA) in predicting the peritoneal recurrence after curative resection of gastric cancer. The Medline, Embase, Web of Science, Ovid and Cochrane databases, Google Scholar and Vivisimo engines were searched to identify studies reporting on the accuracy of CEA protein or CEA mRNA in predicting the postoperative peritoneal recurrence of gastric cancer. Publication bias was demonstrated by Funnel plots and Egger test. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated and summary receiver operating characteristic curves were generated. Seven and eight studies fulfilled the inclusion criteria for CEA protein and mRNA determination, including 635 and 849 patients, respectively. The pooled sensitivity, specificity and DOR of CEA protein for predicting the peritoneal recurrence were 0.77 (95 % CI 0.69-0.84), 0.89 (95 % CI 0.86-0.92), 29.71 (95 % CI 10.27-85.92), respectively. Similarly, the values for CEA mRNA were 0.82 (95 % CI 0.75-0.88), 0.82 (95 % CI 0.79-0.85) and 22.97 (95 % CI 10.90-48.41). Meanwhile, the sensitivity and DOR of CEA protein or mRNA were higher than those of cytology, while higher specificity was noted in cytology assay. CEA protein and mRNA levels in peritoneal lavage show a high diagnostic accuracy and may help accurately predict the peritoneal recurrence after curative resection of gastric cancer.
    Irish Journal of Medical Science 12/2013; 183(4). DOI:10.1007/s11845-013-1051-6 · 0.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to determine the ratio of patients with positive peritoneal cytology who underwent radical gastrectomy for gastric cancer, to evaluate the factors effecting risk of positive cytology and to analyze the effects cytology findings on survival. Peritoneal lavage samples were obtained from 255 patients who underwent radical gastrectomy with D2 (184 patients) or D3 (71 patients) lymph node dissection between January 2000 and December 2007. Thirty-six (14.1%) of 255 patients had free cancer cells in the wash cytology samples. T stage (T4) and differentiation were found to be independent risk factors for positive peritoneal cytology in multivariate analysis. Survival rate of cytology negative patients was significantly higher, however cytology findings were not found to be an independent prognostic factor for survival. T stage, lymph node metastasis and Borrmann classification (Borrmann type 4) appeared to be independent prognostic factors for survival in multivariate analyses. Peritoneal cytology does not provide additional information according to the TNM (1997) staging system. However, it should be employed intraoperatively before potentially curable serosa involved gastric carcinomas, especially for T4 tumors. Surgery alone will not be enough for patients with positive cytology and further therapies should be employed.
    Hepato-gastroenterology 12/2011; 59(117):1657-60. DOI:10.5754/hge11562 · 0.91 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The role of peritoneal washing cytology in determining further treatment strategies after surgery for gastric cancer remains unclear. One reason for this is the fact that optimal procedures to increase the accuracy of predicting peritoneal metastasis have not been established. The aim of this study was to evaluate the efficacy of cytology using samples harvested from two different abdominal cavity sites during gastric cancer surgery. We prospectively recruited 108 patients who were clinically diagnosed with locally advanced gastric cancer (higher than cT1 stage disease). Peritoneal washing fluids were collected from the pouch of Douglas and the subphrenic area. Patients were prospectively followed up for 2 years to determine the recurrence and survival rates. Thirty-three patients dropped out of the study for various reasons, so 75 patients were included in the final analysis. Seven patients (9.3%) showed positive cytology findings, of whom, three showed peritoneal recurrence. Tumor size was the only factor associated with positive cytology findings (P=0.037). The accuracy and specificity of cytology for predicting peritoneal recurrence were 90.1% and 94.2%, respectively, whereas the sensitivity was 50.0%. The survival rate did not differ between patients with positive cytology findings and those with negative cytology findings (P=0.081). Peritoneal washing cytology using samples harvested from two different sites in the abdominal cavity was not able to predict peritoneal recurrence or survival in gastric cancer patients. Further studies will be required to determine whether peritoneal washing cytology during gastric cancer surgery is a meaningful procedure.
    03/2014; 14(1):23-31. DOI:10.5230/jgc.2014.14.1.23