Serosal Scraping of Cancer Specimens Aids the Detection of Serosal Penetration by Invasive Carcinoma.
Nicole C Panarelli, Suzanne M Brandt, Rhonda K Yantiss. Weill Cornell Medical College, New York, NY
Background: American Joint Committee on Cancer (AJCC) staging guidelines for abdominal colon cancers require perforation by tumor or histologic documentation of tumor cells on the serosa for pT4a designation. We, and others, believe that tumor cells within <1mm of the serosa that are associated with an inflammatory reaction likely represent peritoneal involvement by cancers that would otherwise be categorized as pT3. The purpose of this study was to determine whether cytologic preparations obtained from the serosal surface aid the detection of serosal penetration.
Design: Serosal scrapings with the edge of a glass slide were obtained from 16 abdominal colon cancer specimens prior to opening the specimen. The material was smeared on a glass slide, stained with hematoxylin and eosin, and evaluated for the presence of malignant cells. Colon cancers were routinely processed with four sections obtained from the area of deepest penetration, and the tumors were staged according to the AJCC 7th edition staging manual. The findings in cytology specimens were compared to the histologic extent of disease.
Results: There were 7 men and 9 women in the study group (mean 61 years) which included 2 pT1, 1 pT2, 8 pT3, 4 pT4a, and 1 pT4b tumors. Cytology preparations from all pT1 and pT2 cancers contained mesothelial cells and red blood cells and were negative for malignancy, whereas all 5 pT4 cancers had positive cytology specimens. Five of eight (63%) scrape preparations from pT3 tumors were negative for malignant cells, but 3 contained carcinoma. Histologic sections from all 3 latter cases showed carcinoma cells within <1mm of the serosal surface which also showed an inflammatory reaction. All 5 pT3 tumors with negative cytology specimens contained tumors >2mm from the serosa, which was normal histologically.
Conclusions: Cytology preparations obtained from serosal scrapings enhances detection of serosal penetration by cancer cells, and is superior to currently accepted histologic criteria for pT4a designation. Our results support the belief that colon cancers in close proximity to the serosa, in association with a fibroinflammatory reaction, have violated the peritoneum and should be designated as pT4a, not pT3, tumors.
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 59, Wednesday Morning