IMPORTANCE OF CELL BLOCK WITH IMMUNOCYTOCHEMICAL EVALUATION IN CARCINOMATOUS PERITONEAL EFFUSIONS OF UNKNOWN PRIMARY IN FEMALES
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 4, Pages 3401-3412
AbstractBackground: Diagnosis of carcinomatous cells in peritoneal and pleural effusions is important for staging procedures and resulting therapeutic decisions. Various methods are available like routine smears, cell blocks, liquid based cytology etc. for cytological diagnosis. Difficulties are often faced to detect site of primary in carcinomatous effusions due to overlap in the morphologic features from various sites. Various ancillary studies have been used to increase the diagnostic accuracy of cytology. Immunocytochemical analysis is the most commonly used “special” technique and often involves the use of a panel of antibodies. Neoplasms of breast, lung is most common cause of carcinomatous pleural effusion in females and males respectively. Most common primary neoplasms causing carcinomatous peritoneal effusions in females are carcinomas of ovary and in males common sites of carcinomatous effusion include colon, rectum and stomach. The aim of this study is to immunocytochemically evaluate carcinomatous peritoneal effusions in females using cell block.
Materials and Methods: Study included 850 cases of effusion in one and a half years of which 50 (5.9 %) were positive for malignancy. Most patients were in age group of 40-60 years, Cell blocks were made of effusion fluids and immunocytochemical markers Calretenin,CK 7, CDX-2,WT-1,PAX-8 were used.
Results: 44 cell blocks (88%) were adequate in terms of cellularity and malignant cells. Out of 44 , 38 were peritoneal fluids. 35/38 (92%) were concluded as ovarian primary, 03/38 (8%) as gall bladder primary. All the cases showed positivity for CK7, none of them showed positivity for Calretenin ruling out possibility of mesothelioma. We concluded the positivity of WT-1 in 18 out of 35 cases (51.42 %) with a sensitivity of 51.4 %, specificity of 100 %, PPV of 100 %, NPV of 34.6 %. PAX-8 was positive in 25 out of 35 cases (71.43 %) with a sensitivity of 71.43 %, specificity of 100 %, PPV of 100 %,NP V of 47.37 %. On combining WT-1 and PAX-8 the sensitivity increased to 74.29 %, specificity of 100 %, PPV of 100 %, NPV of 50 %.
Conclusion: PAX-8 is more sensitive marker than WT-1 for peritoneal effusion with ovarian primary. Sensitivity further increases on combining both the markers. CDX-2 were positive in all the 3/3 cases of Gastrointestinal tract with Sensitivity, specificity, PPV, NPV of 100 %.
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