Peritoneal Washings and Ovary
nondiagnostic material such as proteinaceous material and
blood—reported in 47% of aspirates from malignant cysts in
When diagnostic material is obtained, the diagnostic accu-
racy reported by experienced observers is generally quite high.
An early study of FNA of palpable masses, many of which were
solid tumors, revealed a sensitivity of 93% and specificity of
95%.35 False-positive diagnoses are rare but may occur with cel-
lular follicle cysts or serous cystadenomas with atypia.51,52,55,61
Other studies have shown the sensitivity of ovarian cyst fluid
cytology to be as low as 25%, with a false-negative rate of 12%
and false-positive rate as high as 73%.40
Peritoneal cytology has an important role in the diagnosis and
staging of abdominal and pelvic malignancies. Diagnostic pit-
falls can be avoided by having an understanding of the different
methods of sampling, a familiarity with cytomorphology of the
various specimen types, adequate clinical history, and an ability
to prepare cell blocks and/or review other prior or concurrent
specimens. Ancillary techniques such as immunohistochem-
istry may be useful in selected cases. More recently molecular
methods have been shown to have potential for allowing iden-
tification of small numbers of cancer cells from body fluids not
apparent on morphology alone.
FNA has become a useful diagnostic and therapeutic tool in
the evaluation of clinically and sonographically nonsuspicious
cystic ovarian masses due to increasing experience in the cyto-
logic interpretation of cystic fluids and improvements in the
technology of high-frequency sonography. Key diagnostic fea-
tures of non neoplastic and neoplastic ovarian cysts have been
described. When representative samples are obtained the diag-
nostic accuracy is high. Careful evaluation of clinical and ultra-
sonographic information should be applied to all cysts prior to
aspiration to limit the risk of aspirating a malignant neoplasm
and possible peritoneal seeding.
Yazigi R, Sandstad J, Munoz AK.
Primary staging in ovarian tumors of
low malignant potential.
Geisinger Kr, Ng LW, Hopkins MB,
et al. Tenckhoff catheter cytology in
patients with ovarian cancer.
Fedare O, Mariappan MR, Hileeto D, et
al. Upstaging based solely on positive
peritoneal washing does not affect out-
come in endometrial cancer.
Wong FC, Pang CP, Tang SK et al. Treat-
ment results of endometrial carcinoma
with positive peritoneal washing, adnexal
involvement and serosal involvement.
Oncol(R Coll Radiol)
Ito K, Noda K. Peritoneal cytology in
patients with uterine cervical carcinoma.
Kodera Y, Yamamura Y, Ito S, et al. Is Bor-
mann type IV gastric carcinoma a surgical
disease? An old problem revisited with ref-
erence to the result of peritoneal washing
de Manzoni G, Di Leo A, Tomezzoli A,
et al. Prognostic value of peritoneal lav-
age cytology in gastric cancer.
Yachida S, Fukushima N, Sakamoto M,
et al. Implication of peritoneal wash-
ing cytology in patients with potentially
resectable pancreatic cancer.
Br J Surg
Jadhon ME, Morgan MA, Kelsten ML,
et al. Cytologic smears of peritoneal
surfaces as a sampling technique in
epithelial ovarian carcinoma.
Vercellini P, Vendola N, Bocciolone L,
et al. Reliability of the visual diagnosis
of ovarian endometriosis.
Fukiwara K, Yamauchi H, Yoshida T, et al.
Relationship between peritoneal
washing cytology through implantable
port system and second-look laparotomy
in ovarian cancer patients with
unmeasurable residual diseases.
12. Hsiu JG, Given FT Jr, Kemp GM. Tumor
implantation after diagnostic laparo-
scopic biopsy of serous ovarian tumors of
low malignant potential.
13. Lo KW, Cheung TH, Yim SF, et al.
Prospective self-controlled study on pre-
vention of hysteroscopic dissemination
in endometrial carcinoma.
Int J Gynecol
14. Salveggi SM. Diagnostic pitfalls of
peritoneal washing cytology and the role
of cell blocks in their diagnosis.
15. Zuna RE, Mitchell ML. Cytologic findings
in peritoneal washings associated with
benign gynecologic disease.
16. Zaytsev P, Taxy JB. Pregnancy-associ-
ated ectopic decidua.
Am J Surg Pathol
17. Lenneau GS, McLaughlin D, O'Boyle J, et
al. Well differentiated papillary mesothe-
lioma of the uterine serosa identified at
cesarean section: a case report.
18. Kern WH. Benign papillary structures
with psammoma bodies in culdocentesis
19. Wojcik EM, Naylor B. "Collagen balls"
in peritoneal washings: prevalence,
morphology, origin and significance.
20. Benevolo M, Mariani L, Vocaturo G,
et al. Independent prognostic value of
peritoneal immunocytodiagnosis in
Am J Surg Pathol
21. Nomoto S, Nakao A, Kasai Y, et al.
Peritoneal washing cytology combined
with immunocytochemical staining and
detecting mutant K-ras in pancreatic
cancer: comparison of the sensitivity and
availability of various methods.
22. Kodera Y, Nakanishi H, Ito S, et al.
Quantitative detection of disseminated
cancer cells in the greater omentum
of gastric carcinoma patients with
real-time RT-PCR: a comparison with
peritoneal lavage cytology.
23. To EM, Chan WY, Chow C, et al.
Gastric cancer cell detection in perito-
neal washing: cytology versus RT-PCR
for CEA transcripts.
Diagn Mol Pathol
24. Nieh S, Chen SF, Fu E, et al. Detection of
the human telomerase RNA component
by in situ hybridization in cells from
25. Copeland LJ, Gershenson DM, Wharton
JT, et al. Microscopic disease at second-
look laparotomy in advanced ovarian