Original Scientific Articles
Positive peritoneal cytology predicts unresectability of pancreatic adenocarcinoma

Presented in part at the 83rd Clinical Congress of the American College of Surgeons, Chicago, IL, October 1997.
https://doi.org/10.1016/S1072-7515(98)00327-5Get rights and content

Abstract

Background: Peritoneal cytology is clinically useful in gastric and gynecologic malignancies. Its role in pancreatic adenocarcinoma remains less well defined. Controversy exists as to the relationship between percutaneous fine needle aspiration (FNA) of the pancreas and shedding of malignant cells with the peritoneum. The aim of this study was to determine whether positive peritoneal cytology (PPC) predicts unresectability of pancreatic adenocarcinoma and impacts on overall survival. In addition, the study aimed to determine whether antecedent FNA increases the incidence of PPC.

Study Design: Between January 1993 and June 1996, 228 patients with radiographically resectable pancreatic adenocarcinoma underwent laparoscopic staging. Specimens were taken from right and left upper quadrants at the beginning of laparoscopy. Various prognostic factors were analyzed.

Results: PPC was identified in 34 patients (15%). Of patients that had an antecedent FNA, 20% had PPC, and 13% of those without an antecedent FNA had PPC (p = 0.22). The majority of patients with PPC had stage IV disease (26 of 34 [76%]) and only 8 (24%) had no evidence of metastases. Overall survival was significantly higher in patients with negative peritoneal cytology (NPC) compared with PPC (p < 0.0006). PPC had a positive predictive value of 94.1%, specificity of 98.1%, and a sensitivity of 25.6% for determining unresectability of pancreatic adenocarcinoma. PPC was not an independent prognostic variable for survival on multivariate analysis.

Conclusions: PPC is associated with advanced disease and is highly specific in predicting unresectability of pancreatic adenocarcinoma, resulting in decreased survival. Antecedent FNA is not associated with an increased the incidence of PPC, nor does it significantly impact on overall survival.

Section snippets

Methods

Between January 1993 and July 1996, 228 patients referred to Memorial Sloan-Kettering Cancer Center with pancreatic tumors considered potentially resectable after dynamic, contrast-enhanced CT scan underwent laparoscopic staging and had peritoneal cytology samples sent for evaluation. Only patients who had histologically confirmed pancreatic adenocarcinoma either after resection or during laparoscopic staging were included in this study.

Results

Of the 228 patients included in this study, there were 122 females and 106 males with an average age of 64.5 ± 10.5 years. Median followup time for this study was 8.8 months. Followup for survivors was 14.4 months.

Discussion

The results of this study show that PPC in patients with pancreatic adenocarcinoma is seen mainly with advanced disease and leads to a significantly lower rate of pancreatic resection when compared with NPC. If positive, peritoneal cytology is highly specific and has a high predictive value in determining resectability. On the other hand, the sensitivity of this evaluation is lacking.

Review of the published literature assessing the role of peritoneal cytology in pancreatic adenocarcinoma is

References (33)

  • D.C Carter

    Cancer of the pancreas

    Gut

    (1990)
  • K.C Conlon et al.

    Long-term survival after curative resection for pancreatic ductal adenocarcinoma

    Ann Surg

    (1996)
  • F.Y Ahmed et al.

    Natural history and prognosis of untreated stage I epithelial ovarian carcinoma

    J Clin Oncol

    (1996)
  • D.A Turner et al.

    The prognostic significance of peritoneal cytology for stage I endometrial cancer

    Obstet Gynecol

    (1989)
  • N Kaibara et al.

    Relationship between area of serosal invasion and prognosis in patients with gastric carcinoma

    Cancer

    (1987)
  • A.L Warshaw et al.

    Preoperative staging and assessment of resectability of pancreatic cancer

    Arch Surg

    (1990)
  • Cited by (71)

    • Human Trial of a Genetically Modified Herpes Simplex Virus for Rapid Detection of Positive Peritoneal Cytology in the Staging of Pancreatic Cancer

      2016, EBioMedicine
      Citation Excerpt :

      The current standard method of detection relies on cytologic evaluation of harvested cells according to for cytomorphologic characteristics of malignant transformation. This test is highly specific and clinically relevant: positive results are associated with very poor prognosis, early intraabdominal recurrence, and death (Jimenez et al., 2000a; Gold et al., 2007; Ferrone et al., 2006; Merchant et al., 1999; Bentrem et al., 2005; Burke et al., 1998; Yachida et al., 2002; Yoshimura et al., 1984). However, when very few free cancer cells are present in the peritoneum, they may be difficult to identify by cytomorphologic criteria alone.

    • Tumors of the Pancreas

      2010, Sleisenger and Fordtran’s Gastrointestinal and Liver Disease- 2 Volume Set: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition - Enhanced Online Features and Print
    • Predicting positive peritoneal cytology in pancreatic cancer

      2021, Journal of Cancer Research and Clinical Oncology
    • Special considerations for peritoneal washings

      2020, The International System for Serous Fluid Cytopathology
    View all citing articles on Scopus

    Supported by an educational grant from the Milton and Bernice Stern Foundation.

    View full text