The Clinical Significance and Detection of Intraperitoneal Micrometastases by ThinPrep(R) Cytology with Peritoneal Lavage Fluid in Patients with Advanced Gastric Cancer

PURPOSE: Peritoneal lavage cytology is regarded as a useful diagnostic test for detecting intraperitoneal micrometastsis. However, there are currently no reports about cytological examination with ThinPrep(R) (CY), a newly introduced fluid-based diagnostic system, in patients with advanced gastric cancer (AGC). This study was performed to analyze the clinical significance of intraoperative peritoneal lavage for CY in AGC patients. MATERIALS AND METHODS: 424 AGC patients were suspected to have serosal exposure macroscopically during surgery and they underwent intraoperative peritoneal lavage for CY between 2001 and 2006 at Korea Cancer Center Hospital. The clinical data, pathological data and CY results were collected and analyzed retrospectively. RESULTS: The percentage of cytology positive results was 31.1%, and this was well correlated with the T-stage, N-stage and P-stage. The 3-year survival rates of CY0 and CY1 were 68.1% and 25.9%, respectively. According to the P-stage and CY, the 3-year survival rates were 71.1% in P0CY0, 38.9% in P0CY1, 38.5% in P1/2/3CY0 and 11.0% in P1/2/3CY1. Interestingly, both the P0CY1 and P1/2/3CY0 survival curves were similar figures, but they were significantly different from those of the other groups. Multivariate analysis indicated that CY was an independent, strong prognostic factor for survival, as well as sex, the T-stage, N-stage, P-stage, other metastasis and the serum CEA. CY1 was revealed as a risk factor for peritoneal recurrence in the curative resection group. CONCLUSION: The results certify indirectly that cytological examination using ThinPrep(R) is a very reliable diagnostic method for detecting intraperitoneal micrometastasis from the fact that it is not only a strong prognostic factor, but it is also a risk factor for peritoneal recurrence in AGC patients. Therefore intraoperative peritoneal lavage should be included in the routine intraoperative staging workup for AGC, and its result will provide a good target for the treatment of peritoneal micrometastasis.

Diagnostic Value of Urine Cytology in 236 cases; a Comparison of Liquid-Based Preparation and Conventional Cytospin Method / 대한세포병리학회지

Urine cytology is an important screening tool for urinary tract neoplasms. Liquid-based preparation methods, such as ThinPrep(R), have been introduced for non-gynecological samples. We aimed to assess the diagnostic accuracy of liquid-based preparations in urine cytology by comparing the results of the conventional Cytospin preparation method for the same samples. A total of 236 cases subject to urine cytology were enrolled in this study from January 2005 to December 2005. All cases were subjected to cystoscopy and if a malignancy was suspected, a biopsy was performed. Urine cytology slides were made using the ThinPrep(R) preparation method and the conventional Cytospin and/or direct smear method from the individual samples. The results of urine cytology were compared with the final cystoscopic or histological diagnoses. We analyzed the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of both cytology preparation methods. A total of 236 slides made using the liquid based method were satisfactory for slide quality, whereas 5 slides (2.1%) prepared by conventional methods were unsatisfactory because of air-drying, a thick smear, or a bloody or inflammatory background. The ThinPrep(R) method showed 53.1% sensitivity, 92.6% specificity, a 92.6% positive predictive value, a 94.1% negative predictive value and 85.6% accuracy, while the conventional method showed 51% sensitivity, 98.4% specificity, a 92.6% positive predictive value, a 98.4% negative predictive value and 88.6% accuracy. Although the diagnostic values were equivalent between the use of the two methods, the quality of the cytology slides and the time consumed during the microscopic examination for a diagnosis were superior for the ThinPrep(R) method than for the conventional method. In conclusion, our limited studies have shown that the use of the liquid based preparation method is beneficial to improve the quality of slides and reduce the duration for a microscopic examination, but did not show better sensitivity, accuracy and predictive values.

The comparative evaluation of clinical screening in combined tests cytology (ThinPrep(R)), HPV DNA test (Hybrid capture(R) II),cervicography for uterine cervical cancer / 부인종양

OBJECTIVE: Since the accuracy of Pap smear for cervical neoplasm has been questioned, a number of adjunctive tests have been developed. The purpose of this study was to evaluate which protocol is the most effective screening test among cervical cytology (ThinPrep(R)), HPV DNA test (Hybrid capture(R) II) and cervicography. METHODS: We chose 252 patients who were underwent the biopsy among 829 patients who visited our hospital for cervical cancer screening test. These 252 patients were engaged in this study simultaneously. They underwent triple combined test [cervical cytology (ThinPrep(R)), HPV DNA test (Hybrid capture(R) II), cervicography] and colposcopic-directed biopsy or biopsy on operation for diagnostic evaluation. RESULTS: The triple combined test showed a sensitivity of 96.0%, while double combined test [cervical cytology (ThinPrep(R))+cervicography] showed a sensitivity of 89.0%, the other double combined test [cervical cytology (ThinPrep(R))+HPV DNA test (Hybrid capture(R) II)] showed a sensitivity of 86.7%. Cervicography showed a specificity of 75.4% (highest among the single test), positive predictability of 89.8% (also highest). CONCLUSION: The sensitivity of cervical cytology was markedly improved by combination with HPV DNA test and cervicography. So the triple combined tests which improved the high false negative rate of cervical cytology may be a new effective method as a cervical cancer screening test, if the effectiveness could be confirmed by mass screening study.