2017

Relationship between positive peritoneal fluid cytology and the type of the malignancy in patients with malignancy related ascites

Aim: Malignancy related ascites may be due to abdominal origin, extraabdominal origin and primary peritoneal malignancy. The relationship between positive peritoneal fluid cytology and the type of the malignancy and the burden of the tumor in the abdomen was investigated.Materials and Methods: One-hundred eighty-nine consecutive patients with malignancy who were examined for ascites fluid cytology were retrospectively identified in the last two years. Age, gender, primary tumor site, radiologic imaging and pathology results of the patients were recorded. According to the abdominal imaging at the time of the paracentesis procedure, the extensiveness of disease in the abdomen was classified as only ascites, ascites with peritoneal carcinomatosis, ascites with liver involvement (primary tumor or metastases) and ascites with peritoneal carcinomatosis with liver involvement.Results: Out of 189 patients, 119 patients (63.0%) were female. The primary tumor site was ovary in 49 patients, stomach in 38 patients, pancreatobiliary system in 37 patients, breast in 16 patients, colorectal in 14 patients, uterine in 13 patients, kidney or bladder in 6 patients, liver in 6 patients, lymphoma in 4 patients, malignant mesothelioma in 3 patients, lung in 2 patients and skin in one patient. Peritoneal fluid cytology revealed malignant cells in 102 patients (54.0%), while 87 patients (46.0%) had benign results. There was a relationship between primary tumor site and malignant cell detection in the fluid (p= 0.001). The detection of malignant cells was correlated with abdominal extensiveness of disease as well (p = 0.01). In multivariate analysis, only primary tumor site [(p = 0.001), risk ratio: 2.28, 95% confidence interval: 1.83-2.73] was the independent factor affecting cytologic positivity.Conclusion: Considering primary tumor site and the extensiveness of disease in the abdomen, primary tumor site was the most important factor affecting peritoneal fluid positivity.

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1. Gerhild Becker. Ascites. Supportive Oncology 2011;362-8. 2. Runyon BA. Care of patients with ascites. N Engl J Med 1994;330:337-42. 3. Barni S, Cabiddu M, Ghilardi M, et al. A novel perspective for an orphan problem: Old and new drugs for the medical management of malignant ascites. Crit Rev Oncol Hematol 2011;79:144-53. 4. Runyon BA, Hoefs JC, Morgan TR. Ascitic fluid analysis in malignancy-related ascites. Hepatology 1988;8:1104-9. 5. Falconieri G, Zanconati F, Colautti I, et al. Effusion cytology of hepatocellular carcinoma. Acta Cytol 1995;39:893. 6. Hodge C, Badgwell BD. Palliation of malignant ascites. J Surg Oncol 2019;120:67-73. 7. Decker D, Stratmann H, Springer W, et al. Benign and malignant cells in effusions: diagnostic value of image DNA cytometry in comparison to cytological analysis. Pathol Res Pract 1998;194:791-5. 8. Kielhorn E, Schofield K, Rimm DL. Use of magnetic enrichment for detection of carcinoma cells in fluid specimens. Cancer 2002;94:205-11. 9. Allen VA, Takashima Y, Nayak S, et al. Assessment of false-negative ascites cytology in epithelial ovarian carcinoma: A study of 313 patients. Am J Clin Oncol 2017;40:175-7. 10. Baransi S, Michaan N, Gortzak-Uzan L, et al. The accuracy of ascites cytology in diagnosis of advanced ovarian cancer in postmenopausal women prior to neoadjuvant chemotherapy. Menopause 2020. 11. Adam RA, Adam YG. Malignant ascites: past, present, and future. J Am Coll Surg 2004;198:999-1011. 12. Ayantunde AA, Parsons SL. Pattern and prognostic factors in patients with malignant ascites: a retrospective study. Ann Oncol 2007;18:945-9. 13. Sangisetty SL, Miner TJ. Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measures. World J Gastrointest Surg. 2012;4:87-95. 14. Garrison RN, Kaelin LD, Galloway RH, et al. Malignant ascites. Clinical and experimental observations. Ann Surg 1986;203:644-51. 15. Malik I, Abubakar S, Rizwana I, et al. Clinical features and management of malignant ascites. J Pak Med Assoc 1991;41:38-40. 16. Cavazzoni E, Bugiantella W, Graziosi L, et al. Malignant ascites: pathophysiology and treatment. Int J Clin Oncol. 2013;18:1-9. 17. Tsikouras P, Tsagias N, Pinidis P, et al.The contribution of catumaxomab in the treatment of malignant ascites in patients with ovarian cancer: a review of the literature. Arch Gynecol Obstet 2013;288:581-5. 18. Maeda H, Kobayashi M, Sakamoto J. Evaluation and treatment of malignant ascites secondary to gastric cancer. World J Gastroenterol 2015;21:10936-47. 19. Chopra N, Kumar S, Chandra A. Malignant Ascites: A Review of Pathogenesis and Management. Open Access J Surg. 2017;2:555596. 20. Zebrowski BK, Liu W, Ramirez K, et al. Markedly elevated levels of vascular endothelial growth factor in malignant ascites. Ann Surg Oncol 1999;6:373-8. 21. Olopade OI, Ultmann JE. Malignant effusions. CA Cancer J Clin. 1991;41:166-79. 22. Press OW, Press NO, Kaufman SD. Evaluation and management of chylous ascites. Ann Intern Med 1982;96:358.