ABSTRACT
Serous effusions occur as a manifestation of a variety of different diseases of a benign and malignant nature. Cytological diagnosis of serous effusions is based upon the distinction between benign and malignant cells at the light microscope level. This differentiation is not easy to perform in all cases due to the fact that benign reactive mesothelial cells may resemble the cells derived from adenocarcinoma or mesotheliomas. This study is an attempt to improve the diagnostic accuracy of the cytological diagnosis of malignant effusions by investigating cytologic and immunocytochemical changes in cells exfoliated in those effusions. A total of [50] inpatients with effusions [pleural and ascitic], and having a high risk of malignancy were included in this study. Effusion fluids were aspirated. All of the 50 specimens obtained were processed and examined by conventional cytologic technique and immunocytochemical technique using 2 monoclonal antibodies [p53 and CEA]. All of the cases were followed up and the final clinical diagnosis were recorded that included various other investigations done including histopathology and the final clinician's opinion. The final clinical diagnosis was regarded then as the gold standard for comparative statistical work of this study. The final clinical diagnosis revealed that 36 [72%] cases were malignant and 14 [28%] were benign. The sensitivity of cytology was 86.1%; specificity was 92.85%, with an overall accuracy of 88%. While the sensitivity, specificity, and accuracy of p53 were [63.8%, 92.8%, 72%] and of CEA were [72.22%, 85.7%, 76%] respectively. combined p53 and CEA results showed a sensitivity of 83.33%, specificity of 85.71%, and an accuracy of 84%. And when both cytology and immunocytochemistry were combined in parallel the sensitivity was 91.66%, specificity was 85.7%, and the accuracy was 90%. Adenocarcinoma of lung followed by that of breast were the most frequent primary tumors metastasizing to the pleural cavity. While adenocarcinoma of the ovary and stomach were the most frequent primary tumors metastasizing to the peritoneal cavity. It is concluded that using 2 or more [panel] selected monoclonal antibodies will surely enhance the accuracy of immunocytochemical technique for malignancy detection while combined cytology and immunocytochemistry have higher accuracy than each of them alone