ABSTRACT
Clinical investigations with imaging- and endoscopic techniques in order to identify the primary tumor sites in patients with CUP syndrome generally entail a significant diagnostic effort. If costs exceed
Subject(s)
Ascitic Fluid/pathology , Biomarkers, Tumor/analysis , Biopsy, Fine-Needle , Immunohistochemistry/methods , Liver Neoplasms/pathology , Liver Neoplasms/secondary , Lymphatic Metastasis/pathology , Neoplasms, Unknown Primary/pathology , Peritoneal Neoplasms/secondary , Pleural Effusion, Malignant/pathology , Algorithms , Carcinoma, Bronchogenic/pathology , Carcinoma, Bronchogenic/secondary , Carcinoma, Hepatocellular/pathology , Colonic Neoplasms/pathology , Diagnosis, Differential , Female , Humans , Liver/pathology , Lung Neoplasms/pathology , Lymph Nodes/pathology , Male , Mesothelioma/pathology , Mesothelioma/secondary , Ovarian Neoplasms/pathology , Peritoneal Neoplasms/pathology , Pleural Neoplasms/pathologyABSTRACT
OBJECTIVE: To compare the results of conventional cytology, DNA image cytometry, immunocytochemistry and argyrophilic nucleolar organizer region (AgNOR) analysis for the diagnosis of malignant cells in serous effusions. STUDY DESIGN: One hundred twenty effusions, 40 with carcinoses, 40 with malignant mesotheliomas and 40 without tumor cells on follow-up were studied by conventional cytology and three adjunctive methods. RESULTS: Unequivocal tumor cells were detected in 92.5% of effusions due to carcinoses and in 45% due to mesotheliomas. Applying immunocytochemistry with BerEP-4 positivity and DNA image cytometry with aneuploidy as a marker revealed 100% of carcinoses and 71.7% of mesotheliomas. Applying the experimentally found thresholds of 2.5 AgNORs as "satellites" and 4.5 AgNORs as "satellites and clusters" together as mean values per nucleus resulted in a 95% correct rate of mesothelioma and 100% rate of carcinoma cell identification without false positive diagnoses. CONCLUSION: AgNOR analysis may be a useful adjunct to other methods in the routine diagnosis of malignant serous effusions. It seems to be the most sensitive method in early cytologic diagnosis of mesotheliomas in effusions. Seventy-three percent of malignant mesotheliomas were diagnosed cytologically at first on effusions. Forty-seven percent of patients with malignant mesotheliomas were identified at the early tumor stage T1 N0 M0.