Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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The Shorr Versus Modified Ultrafast Papanicolaou Method for Intraoperative Diagnosis of Peritoneal Washing Cytology in Advanced Gastric Cancer: A Phase II Study

  • So Hyun Kang (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Hee Young Na (Department of Pathology, Seoul National University Bundang Hospital) ;
  • Younghwa Choi (Department of Pathology, Seoul National University Bundang Hospital) ;
  • Eunju Lee (Department of Surgery, Chung-Ang University Gwangmyeong Hospital) ;
  • Mira Yoo (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Duyeong Hwang (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Sa-Hong Min (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Young Suk Park (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Sang-Hoon Ahn (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Yun-Suhk Suh (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Do Joong Park (Department of Surgery, Seoul National University College of Medicine) ;
  • Hye Seung Lee (Department of Pathology, Seoul National University College of Medicine) ;
  • Hyung-Ho Kim (Department of Surgery, Seoul National University Bundang Hospital)
  • Received : 2023.05.07
  • Accepted : 2023.08.14
  • Published : 2023.10.31
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Abstract

Purpose: According to the American Joint Committee on Cancer cancer staging system, positive peritoneal washing cytology (PWC) indicates stage IV gastric cancer. However, rapid intraoperative diagnosis of PWC has no established reliable method. This study evaluated and compared the diagnostic accuracy of the Shorr and the modified ultrafast Papanicolaou (MUFP) methods for intraoperative PWC. Materials and Methods: This study included patients with gastric cancer who were clinically diagnosed with stage cT3 or higher. The Shorr and MUFP methods were performed on all PWC specimens, and the results were compared with those of conventional Papanicolaou (PAP) staining with carcinoembryonic antigen immunohistochemistry. Sensitivity, specificity, and partial likelihood tests were used to compare the 2 methods. Results: Forty patients underwent intraoperative PWC between November 2019 and August 2021. The average time between specimen reception and slide preparation using Shorr and MUFP methods was 44.4±4.5 minutes, and the average time between specimen reception and pathologic diagnosis was 53.9±8.9 minutes. Eight patients (20.0%) had positive cytology in PAP staining. The Shorr method had a sensitivity of 75.0% and specificity of 93.8%; the MUFP method had 62.5% sensitivity and 100.0% specificity. The area under the curve was 0.844 for Shorr and 0.813 for MUFP. In comparing the C-indices of each method with overall survival, no difference was found among the Shorr, MUFP, and conventional PAP methods. Conclusions: The Shorr and MUFP methods are acceptable for the intraoperative diagnosis of PWC in advanced gastric cancer.

Keywords

Acknowledgement

This study received funding from the Seoul National University Bundang Hospital (SNUBH 14-2017-0024 and SNUBH 14-2018-0027).

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