J Gastric Cancer.  2019 Jun;19(2):173-182. 10.5230/jgc.2019.19.e14.

Rapid Staining Using the Shorr Method for Intraoperative Peritoneal Washing Cytology in Advanced Gastric Cancer: a Pilot Study from a Single Institution

• Son SY
• Choi HY
• Lee Y
• Park YS
• Shin DJ
• Oo AM
• Jung DH
• Ahn SH
• Park DJ
• Lee HS
• Kim HH

• KMID: 2449938
• DOI: http://doi.org/10.5230/jgc.2019.19.e14

Abstract

PURPOSE
Intraoperative peritoneal washing cytology (PWC) is used to determine treatment strategies for gastric cancer with suspected serosal invasion. However, a standard staining method for intraoperative PWC remains to be established. We evaluated the feasibility of a rapid and simple staining method using Shorr's stain for intraoperative PWC in advanced gastric cancer.
MATERIALS AND METHODS
Between November 2012 and December 2014, 77 patients with clinical T3 or higher gastric cancer were enrolled. The sensitivity, specificity, and concordance between the Shorr staining method and conventional Papanicolaou (Pap) staining with carcinoembryonic antigen (CEA) immunohistochemistry (IHC) were analyzed.
RESULTS
Intraoperative PWC was performed laparoscopically in 69 patients (89.6%). The average time of the procedure was 8.3 minutes, and the average amount of aspirated fluids was 83.3 mL. The average time for Shorr staining and pathologic review was 21.0 minutes. Of the 77 patients, 16 (20.7%) had positive cytology and 7 (9.1%) showed atypical findings; sensitivity and specificity were 73.6% and 98.2% for the Shorr method, and 78.9% and 98.2% for the Pap method with CEA IHC, respectively. Concordance of diagnosis between the 2 methods was observed in 90.9% of cases (weighted κ statistic=0.875) and most disagreements in diagnoses occurred in atypical findings (6/7). In overall survival, there was no significant difference in C-index between the 2 methods (0.459 in Shorr method vs. 0.458 in Pap with CEA IHC method, P=0.987).
CONCLUSIONS
Shorr staining could be a rapid and reliable method for intraoperative PWC in advanced gastric cancer.

Keyword

Gastric cancer; Laparoscopy; Intraoperative cytology; Staining

MeSH Terms

Carcinoembryonic Antigen
Diagnosis
Humans
Immunohistochemistry
Laparoscopy
Methods*
Pilot Projects*
Sensitivity and Specificity
Stomach Neoplasms*
Carcinoembryonic Antigen

Figure

• 

  Fig. 1 Schematic of the process of intraoperative peritoneal washing cytology and Shorr staining. In papanicolaou staining, carcinoma cells are easily distinguished from mesothelial cells and inflammatory cells, which show large cell size and nuclear hyperchromasia. It is also possible to easily differentiate between carcinoma cells and other cells by using Shorr staining without drying or any other technical artifacts. PWC = peritoneal washing cytology; Pap = Papanicolaou.

• 

  Fig. 2 Survival according to the results of peritoneal washing cytology. Pap = Papanicolaou; CEA = carcinoembryonic antigen; IHC = immunohistochemistry.

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