Comparison of diaphragmatic wash and scrape specimens in staging of women with ovarian cancer.
OBJECTIVE
The best technique for obtaining cytologic specimens necessary for evaluation of diaphragmatic spread among women undergoing surgical staging for ovarian cancer has yet to be determined. The aim of the current study was to compare two methods for obtaining diaphragmatic cytology-wash and scrape-in accuracy, correlation to clinical findings, and smear quality.


METHODS
We conducted a prospective study among women undergoing surgical staging for ovarian cancer. In each patient diaphragmatic scrape and wash specimens were obtained, then the undersurface of the diaphragm was inspected and palpated. The smears were examined for presence of cancer cells, correlated to clinical findings, and scored for quality (cellularity, preservation, and background).


RESULTS
In 46 consecutive patients with stage I-III ovarian cancer, the diaphragm was clinically involved in 12 (26.1%). Malignant cells were demonstrated in 21 (45.7%) of wash and scrape specimens. There was perfect agreement between washes and scrapes and good agreement between clinical evaluation and scrapes or washes (kappa = 1.0 and 0.592, respectively). Wash specimens had significantly higher overall smear quality and cellularity scores (6.26 +/- 1.26 vs 6.11 +/- 1.06, P < 0.02, and 2.20 +/- 0.81 vs 1.85 +/- 0.76, P < 0.05, respectively).


CONCLUSIONS
Although diaphragmatic wash specimens provide better-quality smears than scrape specimens, both techniques are equally diagnostic of diaphragmatic involvement in women undergoing surgical staging for ovarian cancer.
Eltabbakh
G H
GH
Division of Gynecologic Oncology, University of Vermont College of Medicine, Burlington, Vermont 05401, USA. gamal.etabbakh@vtmednet.org
Mount
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SL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000473:pathology; D003581:Cytodiagnosis / Q000379:methods*; D003964:Diaphragm / Q000473:pathology*; D005260:Female; D006801:Humans; D007813:Laparotomy; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000473:pathology / Q000556:secondary; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000473:pathology; D011446:Prospective Studies; D007507:Therapeutic Irrigation