浆膜腔积液中转移性腺癌与间皮细胞的病理学研究

目的探讨浆膜腔积液中转移性腺癌与反应性间皮细胞增生的鉴别.方法选取胸、腹水转移癌48例及反应性间皮细胞增生30例,采用常规涂片HE染色观察两者形态学特点,并应用免疫细胞化学SP法检测HBME-1、calretinin、E-cadherin、MOC-31和BerEP4的表达.结果腺癌和间皮细胞两者形态各有特点,但是分化好的腺癌和明显增生的间皮细胞仅从常规涂片难以鉴别;免疫细胞化学显示反应性间皮细胞HBME-1和calretinin阳性率为86.7%和76.7%;而腺癌细胞只有少量表达,特异性高达95.8%和100%.MOC-31、E-cadherin和BerEP4对转移性腺癌细胞阳性率为70.8%、77.1%和88.4%,间皮细胞表达很少,特异性分别为90%、93.3%、93%.两者对5种抗体的表现差异显著.结论应用常规涂片和免疫细胞化学相结合的方法对鉴别转移性腺癌和间皮细胞增生有很大的帮助,最好应用一组抗体综合分析判断,HBME-1、Calretinin、E-cadherin、MOC-31及BerEP4是目前非常有效的组合.     

联合检测B72.3、癌胚抗原、神经特异性钙结合蛋白、血栓素在浆膜腔积液细胞学鉴别诊断中的价值

目的探讨B72.3、癌胚抗原、神经特异性钙结合蛋白、血栓素组合检测在浆膜腔积液中恶性间皮瘤和增生间皮细胞与腺癌鉴别诊断的价值。方法取123例浆膜腔积液,经活检或临床资料证实为转移腺癌89例、恶性间皮瘤8例、增生间皮细胞26例,并对细胞学标本做特殊处理后常规涂片,做B72.3、癌胚抗原、神经特异性钙结合蛋白、血栓素免疫细胞化学与苏木素-伊红(HE)染色分析。结果123例积液标本中,B72.3、癌胚抗原诊断腺癌的敏感性分别为80.1%、78.7%,特异性分别为97.1%、97.1%,B72.3、癌胚抗原组合检测诊断转移腺癌的敏感性为95.5%(85/89);神经特异性钙结合蛋白、血栓素诊断间皮源性细胞敏感性分别为88.2%、79.4%,特异性分别为95.5%、91.0%,神经特异性钙结合蛋白、血栓素组合检测诊断间皮源性细胞敏感性为94.1%(32/34),其中恶性间皮瘤为100%(8/8)。结论通过对浆膜腔积液细胞学标本的有效处理和制片技术的改进,选择B72.3、癌胚抗原、神经特异性钙结合蛋白、血栓素组合检测和细致的细胞形态学观察,可进一步提高浆膜腔积液中恶性间皮瘤与转移性腺癌的鉴别诊断。     

Use of immunocytochemical assays in the study of exudates from serous cavities in the practical work of a laboratory

The clinical introduction of new methods for processing fluid samples and the application of supplementary methods for improving the diagnostic accuracy of the pattern of pleurisy is very important for differential diagnosis. The possibilities of using immunocytochemical assay in the practical work of a clinical diagnostic (cytological) laboratory were studied in 96 patients, including 78 and 18 patients with pleural and ascitic fluids, respectively). A Cytospin-IV centrifuge was used for immunocytochemical assay by the routine procedure. The Streptadivin-biotin LSAB2 and EnVision+ test systems were employed to visualize an antigen/antibody reaction. Diaminobenzidine (DAB) was used as a chromogen. A set of markers, comprising 11 antibodies, was applied to the verification of a neoplasm from serous cavities. Mesothelioma was diagnosed in 65 patients. Epithelial mesothelioma was identified in 62 (95.4%) cases. Mesothelioma cells were positive to vimentin and ceratins, calretinin, mesothelin, and thrombomodulin. In 31 cases, adenogenic carcinoma metastases to the serous cavities were typified by an immunopositive reaction to CEA, Ber-EP4, EMA, and cytokeratins and a negative reaction to calretinin, mesothelin, and thrombomodulin. There was occasionally a positive reaction to CD-15 and vimentin.     

肿瘤标志物HE4、CA125、CA199、CA153、AFP在卵巢癌早期诊断中的应用价值

目的探讨肿瘤标志物血清人附睾蛋白4(HE4)、糖类抗原125(CA125)、糖类抗原199(CA199)、糖类抗原153(CA153)、甲胎蛋白(AFP)在早期卵巢癌诊断中的价值。方法选取2014年2月至2016年10月在该院治疗的卵巢肿瘤患者117例,其中卵巢癌组69例,卵巢良性病变组48例,同时选取健康自愿者70例为对照组,检测各受试者血清HE4、CA125、CA199、CA153、AFP水平。结果卵巢癌组HE4、CA125、CA199、CA153、AFP阳性率为59.42%、68.12%、33.33%、46.38%、39.13%,明显高于卵巢良性病变组和对照组(P0.05)。CA125诊断卵巢癌的灵敏度为68.11%,特异度为88.98%,阴性预测值为78.33%,阳性预测值为82.68%,约登指数为0.571,诊断效能优于其他肿瘤标志物指标。经病理检查,69例卵巢癌患者中,浆液性腺癌34例,黏液性腺癌18例,子宫内膜样癌17例。浆液性腺癌CA125阳性率为85.29%,明显高于黏液性腺癌和子宫内膜样癌(χ2=9.398,P0.05)。结论 CA125在卵巢癌早期诊断中有较好的应用价值,在浆液性腺癌中其阳性率较高。     

Genes with bimodal expression are robust diagnostic targets that define distinct subtypes of epithelial ovarian cancer with different overall survival

In some cancer types, certain genes behave as molecular switches, with on and off expression states. These genes tend to define tumor subtypes associated with different treatments and different patient survival. We hypothesized that clinically relevant molecular switch genes exist in epithelial ovarian cancer. To test this hypothesis, we applied a bimodal discovery algorithm to a publicly available ovarian cancer expression microarray data set, GSE9891 [285 tumors: 246 malignant serous (MS), 20 endometrioid (EM), and 18 low malignant potential (LMP) ovarian carcinomas]. Genes with robust bimodal expression patterns were identified across all ovarian tumor types and also within selected subtypes: 73 bimodal genes demonstrated differential expression between LMP versus MS and EM; 22 bimodal genes distinguished MS from EM; and 14 genes had significant association with survival among MS tumors. When these genes were combined into a single survival score, the median survival for patients with a favorable versus unfavorable score was 65 versus 29 months (P < 0.0001, hazard ratio = 0.4221). Two independent data sets [high-grade, advanced-stage serous (n = 53) and advanced-stage (n = 119) ovarian tumors] validated the survival score performance. We conclude that genes with bimodal expression patterns not only define clinically relevant molecular subtypes of ovarian carcinoma but also provide ideal targets for translation into the clinical laboratory.     

卵巢纤维瘤合并腹膜恶性间皮瘤临床病理观察

目的探讨卵巢纤维瘤合并腹膜恶性间皮瘤的诊断与鉴别诊断以及可能的发病机制。方法采用HE染色、免疫组化标记、临床追踪随访并复习文献对卵巢纤维瘤合并腹膜恶性间皮瘤进行观察分析。结果患者女性,60岁。盆腔占位伴大量腹水。组织学上卵巢为巨大纤维瘤,合并腹腔弥漫性上皮样细胞增生,细胞呈乳头状或巢片状分布,异型性不明显,核分裂少见,部分区域肿瘤向脂肪小叶内浸润生长。免疫组化:上皮样细胞MC、CR、D2-40和CK5/6(+),p16和上皮性标记物(-)。结论卵巢纤维瘤合并腹膜恶性间皮瘤罕见,发生机制不清。形态学上容易误诊为卵巢纤维瘤伴弥漫性间皮细胞增生、腹膜或卵巢原发性浆液性肿瘤,免疫标记及临床特征有助于鉴别。     

血清CA125、CA72-4与人附睾分泌蛋白4检测在卵巢癌早期诊断中的临床价值

目的 探讨血清CA125、CA72-4与人附睾分泌蛋白4(human epididymis protein 4,HE 4)联合检测对卵巢癌早期诊断的价值.方法 分别采用ELISA法和电化学发光法测定111例卵巢癌患者(卵巢癌组)、130例良性卵巢疾病患者(良性卵巢疾病组)、90名健康体检者(正常对照组)血清CA125、CA72-4与HE4,分析3种指标单独和联合检测对卵巢癌早期诊断的价值.结果 卵巢癌组CA125、CA72-4与HE 4水平明显高于良性卵巢疾病组和正常对照组(P均＜0.01);Ⅰ期卵巢癌患者的HE4阳性率高于CA125、CA72-4,阳性率分别是63.5%、55.8%、42.6%,而CA125、CA72-4与HE 4联合检测Ⅰ期卵巢癌阳性率较高为75.8%;CA125对浆液性癌、子宫内膜样癌、低分化腺癌诊断敏感性均较高,CA72-4对黏液性癌、子宫内膜样癌诊断敏感性较高,HE 4对浆液性癌、子宫内膜样癌诊断敏感性较高.结论 CA125可作为卵巢癌诊断的首选肿瘤标志物,联合检测血清CA72-4、HE4可使卵巢癌Ⅰ期诊断敏感性提高.

Abstract：

Objective To explore the clinical values of combined detection of serum CA125, CA72-4 and HE4 levels in the early diagnosis of ovarian cancer. Methods The serum levels of CA125, CA72-4 and HE4 in 111 patients with ovarian cancer, 130 patients with benign ovarian disease and 90 healthy female controls were measured by electrochemical luminescence immunoassay (ECLIA) and enzyme-linked immunosorbent assay (ELISA) methods. The diagnostic values of the three markers were analyzed separately and combinedly in ovarian cancer. Results The serum levels of CA125, CA72-4 and HE4 of ovarian cancer patients were significantly higher than those of benign ovarian disease patients and healthy controls(Ps ＜ 0. 01). The positive expression rate of HE4(63.5%) in patients with stage Ⅰ ovarian cancer was significantly higher than that of CA125(55. 8%) and CA72-4 (42. 6%)(Ps ＜ 0. 05) . The combined detection of the three markers may improve the overall accuracy of the early diagnosis of ovarian cancer to 75.8%. The diagnostic sensitivity of serum CA125 was relatively higher in serous cystadenocarcinoma, endometrioid carcinoma and poorly differentiated adenocarcinoma; the diagnostic sensitivity of serum CA72-4 was relatively higher in mucinous cystadenocarcinoma and endometrioid carcinoma; the diagnostic sensitivity of serum HE4 was relatively higher in serous cystadenocarcinoma and endometrioid carcinoma. Conclusion CA125 can serve as the first choice of tumor maker in the diagnosis of ovarian cancer, and the combined detection of serum levels of CA125, CA72-4 and HE4 may increase the diagnostic sensitivity of stage Ⅰ ovarian cancer.     

一组单抗鉴别浆膜转移腺癌细胞与反应性间皮细胞的意义

目的 为提高浆膜转移腺癌细胞的诊断率,探讨一组正反互补单克隆抗体鉴别浆膜转移腺癌细胞与反应性间皮细胞的意义。方法 用低分子量细胞角蛋白（CK^LMW)、癌胚抗原（CEA）及间皮细胞（MC）3种标记物,对50份浆膜腔积液及14份腹腔冲洗液内的细胞进行免疫细胞化学标记。结果 3组细胞与CK^LMW、CEA及MC的表达率分别为：腺癌细胞（95.83%,70.83%,16.67%;可疑癌细胞100%,50.00%,不表达;反应性间皮细胞33.33%,33.33%,66.66%;细胞病理学最初分类的4例可疑癌细胞和2例反应性间皮细胞应归属于腺癌细胞。CK^LMW、CEA及MC3种抗体的敏感度、特异度及可用度分别为96.30%,80.00%,77.10%;70.37%,90.00%,61.60%;90.00%,85.20%,75.30%。结论 免疫细胞化学CK^LMW、CEA及MC联合应用在鉴别浆膜转移腺癌细胞与反应性间皮细胞时,是一项具有重要价值的辅助手段。     

The detection and localization of monocyte chemoattractant protein-1 (MCP-1) in human ovarian cancer.

Chemokines may control the macrophage infiltrate found in many solid tumors. In human ovarian cancer, in situ hybridization detected mRNA for the macrophage chemokine monocyte chemoattractant protein-1 (MCP-1) in 16/17 serous carcinomas, 4/4 mucinous carcinomas, 2/2 endometrioid carcinomas, and 1/3 borderline tumors. In serous tumors, mRNA expression mainly localized to the epithelial areas, as did immunoreactive MCP-1 protein. In the other tumors, both stromal and epithelial expression were seen. All tumors contained variable numbers of cells positive for the macrophage marker CD68. MCP-1 mRNA was also detected in the stroma of 5/5 normal ovaries. RT-PCR demonstrated mRNA for MCP-1 in 7/7 serous carcinomas and 6/6 ovarian cancer cell lines. MCP-1 protein was detected by ELISA in ascites from patients with ovarian cancer (mean 4.28 ng/ml) and was produced primarily by the cancer cells. Human MCP-1 protein was also detected in culture supernatants from cell lines and in ascites from human ovarian tumor xenografts which induce a peritoneal monocytosis in nude mice. We conclude that the macrophage chemoattractant MCP-1 is produced by epithelial ovarian cancer and that the tumor cells themselves are probably a major source. MCP-1 may contribute to the accumulation of tumor-associated macrophages, which may subsequently influence tumor behavior.     

子宫内膜癌19例临床病理分析

目的探讨子宫内膜癌(endometrial carcinoma,EC)的病理组织学类型及组织发生、诊断与鉴别诊断。方法观察19例子宫内膜癌的临床病理特点,并对其免疫表型进行分析。结果患者年龄为37～60岁,平均年龄51.6岁;临床表现为阴道不规则出血、阴道排液。Ⅰ型EC 16例,占84.21%,其中子宫内膜样腺癌15例(Ⅰ级9例、Ⅱ级4例、Ⅲ级2例),黏液腺癌1例;ER(+)、PR(+)、VGFR高表达、Ki-67平均>20%肿瘤细胞(+)、p53(-)。Ⅱ型EC 3例,占15.79%,其中浆液性腺癌2例,病理组织学特点为具有复杂分支的乳头状结构,伴有较宽的纤维血管轴心,乳头由明显复层细胞被覆,细胞具有高度异型性,p53(+)、PR(-)、ER(-)、WT-1(-);子宫内膜癌肉瘤1例,癌成分为高分化子宫内膜样腺癌,肉瘤成分为同源性子宫内膜间质肉瘤,癌成分PCK(+)、肉瘤成分CD10(+)、Vimentin癌和肉瘤成分(+),a-SMA(-)、Desmin(-)、a-ihibin(-)。结论Ⅰ型和Ⅱ型EC具有不同的组织学起源和免疫表型,免疫组织化学鉴别其组织学类型具有重要意义。     

Peritoneal mesothelial cell culture and biology.

The peritoneal mesothelium is composed of an extensive monolayer of mesothelial cells that lines the body's serous cavity and internal organs and was previously thought to act principally as a protective nonadhesive lubricating surface to facilitate intracoelomic movement. With the introduction of peritoneal dialysis over three decades ago, there has been much interest in the cell biology of peritoneal mesothelial cells. Independent studies have highlighted specific properties of the peritoneal mesothelial cell, including antigen presentation, regenerative properties, clearance of fibrin; synthesis of cytokines, growth factors, and matrix proteins; and secretion of lubricants to protect the tissue from abrasion, adhesion, infection, and tumor dissemination. It is now evident that the mesothelium is not merely a passive membrane but, rather, a dynamic membrane that contributes substantially to the structural, functional, and homeostatic properties of the peritoneum. Since peritoneal mesothelial cells in culture possess immunohistochemical markers identical to mesothelial stem cells, the culture of mesothelial cells offers researchers an essential tool to assess their morphologic, structural, and functional properties. This review will discuss current procedures to isolate peritoneal mesothelial cells from human omental specimens, animal sources, and spent dialysate. Furthermore, the functional and morphologic properties of mesothelial cells are discussed, together with the potential use of mesothelial cell culture in research and clinical applications.     

The ultrastructure of selected gynecologic neoplasms

Several articles have been published recently that discuss the role of electron microscopy in the diagnosis and study of gynecologic neoplasms. It becomes apparent from those works and the review just presented that, although an ultrastructural study is not necessary for reaching a diagnosis of many of these tumors, it may be necessary or supportive in identifying the more poorly differentiated ones. Furthermore, electron microscopy is valuable in providing evidence for the histogenesis of some of these neoplasms. Unfortunately for the pathologist, a certain level of morphologic differentiation (and an absence of metaplasia) in a cell is usually necessary for these goals to be achieved. For example, an adenomatoid tumor (see the article by Dr. Srigley, Mr. Toth, and Mr. Edwards in this issue) of the fallopian tube can readily be accepted as being composed of mesothelial cells, because both the neoplastic cells and normal mesothelial cells have the same highly differentiated features of long, slender microvilli, prominent intercellular junctions, and many microfilaments. On the other hand, there is very little resemblance between the granulosa cells of a granulosa-cell tumor and mature mesothelial cells. Thus, if one of the theories of histogenesis of granulosa cells were correct--namely, that they are derived ultimately from mesothelial lining--the ultrastructural evidence would rest on recognizing a similarity between the two types of cells at an earlier stage of differentiation. The neoplastic granulosa cell has differentiated along a separate, specialized line in which the ultrastructural resemblance to the parent cell is partly, if not completely, lost. Another example of the type of information that electron microscopy can provide is in relation to the common epithelial tumors. There is good evidence that the serous tumors in this group arise from mesothelium, although ultrastructurally their differentiation has veered from a mesothelial direction to one in which the cells have a complement of organelles related to secretory activity. Paradoxically, the mucinous cystic tumors, which have been classified traditionally as tumors of surface epithelial origin, are now thought to be of germ-cell origin in some cases, as examples of monophyletic teratomas. The ultrastructural evidence for this conclusion rests on the presence of anchoring filaments in the microvilli of the neoplastic cells, similar to those of normal intestinal epithelium, and on an admixture of various types of gastrointestinal cells, including those that contain dense-core granules (argentaffin cells).(ABSTRACT TRUNCATED AT 400 WORDS)     

卵巢癌患者血清miR-200家族和miR-100检测的临床价值

目的 探讨血清microRNA的表达差异在卵巢癌诊断和治疗中的临床价值.方法 收集149例卵巢肿瘤患者和30例健康体检者,采用qRT-PCR检测受检者血清miR-200a、miR-200b、miR-200c和miR-100的表达情况,对检测结果进行统计学分析.结果 miR-200a、miR-200b和miR-200c在卵巢癌患者血清中表达水平均高于正常对照者,而miR-100在卵巢癌患者血清中表达水平低于对照组,且差异均有统计学意义（P均＜ 0.001）.miR-200a、miR-200b、miR-200c及miR-100在良性肿瘤患者与正常对照者血清中表达水平差异均无统计学意义（P均＞ 0.05）.miR-200a、miR-200b和miR-200c在透明细胞癌的表达水平明显高于浆液性和黏液性癌,且差异均有统计学意义（P均＜ 0.05）.miR-200b在浆液性癌中的表达水平高于黏液性癌,miR-200c在透明细胞癌中的表达水平高于子宫内膜癌,且差异均有统计学意义（P均＜ 0.05）.结论 血清miR-200家族的表达可用于卵巢癌的诊断、疗效监测及预后评估.     

The mesothelial cells in CAPD effluent and their relation to peritonitis incidence

The total cell count and cell differentiation of the overnight peritoneal dialysis effluent (PDE) was analysed in 34 long-term CAPD patients. The mean percentage and yield of mesothelial cells were 3.1% and 0.17 x 10(6) per PDE. There was a significant lower percentage and yield of mesothelial cells in the PDE of patients with a peritonitis incidence (PI) of more than 2 episodes a year. Independent of dwell time, a positive correlation between the total yield of leucocytes and the yield of mesothelial cells was found. No relation between the amount of phospholipids in the PDE and the yield of mesothelial cells could be shown. Mesothelial cells in the PDE are probably reflecting the turn-over rate of a reactive mesothelium. Whether a low turn-over rate of the mesothelium is causing or is caused by a high PI needs further investigation.     

免疫细胞化学与浆膜腔积液细胞学诊断

目的解决浆膜腔积液中疑难病例的确诊、分型,探讨免疫细胞化学在积液中鉴别诊断的价值,找出用于诊断的合适抗体。方法选用6种单克隆抗体:钙视网膜素(CAL)、上皮细胞膜抗原(EMA)、癌胚抗原(CEA)、细胞角蛋白17和18(CK17标记鳞癌,CK18标记腺癌)、波形蛋白(VIM),对58例积液标本进行诊断。结果在58例积液标本中,免疫细胞化学鉴别出恶性积液38例,反应性积液20例。结论CAL、EMA、CEA、VIM联合应用可从正反两方面同时证明癌细胞的存在,是积液中免疫细胞化学的较佳抗体组合。CK17、CK18对鉴别积液中鳞癌、腺癌有参考价值。在细胞学检查中应普遍推广免疫细胞化学。     

Application of Leu M5 (CD 11c) antibody in the cytodiagnosis of body fluids: Preliminary results

Identification of metastatic malignant cells in body fluids and their distinction from reactive mesothelial cells is a common diagnostic problem. Application of the immunoalkaline phosphatase method using epithelial membrane antigen, cytokeratin, vimentin, carcinoembryonic antigen, lysozyme, and leukocyte common antigen (CD 45) is routinely performed in our Hematology Laboratory in conjunction with morphological examination of body fluids. Recently, we found that anti-Leu M₅ (CD 11 c), a monoclonal antibody to human monocyte/macrophage, is frequently reactive to mesothelial cells. We then undertook a prospective study, adding anti-CD 11c to the above-listed antibody panel and applying to cytocentrifuge preparations of body fluid. The neoplastic cells in only 2 out of 34 cases (5.9%) with the diagnosis of metastatic carcinomas reacted positively for CD 11c. The neoplastic cells in four cases of malignant lymphoma were non-reactive for CD 11c. In addition, malignant cells on touch preparations of 25 carcinomas were also negative. Mesothelial cells in all 15 cases of reactive effusions and those mesothelial cells present in malignant effusions were positively stained with CD 11c, although the intensity of staining varied in different mesothelial cells of the same cases. We conclude that anti-CD 11c can be considered as a useful adjunct to the differential diagnosis of malignant effusions. © 1993 Wiley-Liss, Inc.     

Gastrointestinal-type chemotherapy prolongs survival in an atypical primary ovarian mucinous carcinoma: A case report

BACKGROUNDPrimary ovarian mucinous carcinoma is a rare histologic subtype of epithelial ovarian carcinoma and exhibits considerable morphologic overlap with secondary tumour. It is hard to differentiate primary from metastatic ovarian mucinous carcinoma by morphological and immunohistochemical features. Because of the histologic similarity between primary ovarian mucinous carcinoma and metastatic gastrointestinal carcinoma, it has been hypothesized that ovarian mucinous carcinomas might respond better to non-gynecologic regimens. However, the standard treatment of advanced ovarian mucinous carcinoma has not reached a consensus.CASE SUMMARYA 56-year-old postmenopausal woman presented with repeated pain attacks in the right lower quadrant abdomen, accompanied by diarrhoea, anorexia, and weight loss for about 3 mo. The patient initially misdiagnosed as having gastrointestinal carcinoma because of similar pathological features. Based on the physical examination, tumour markers, imaging tests, and genetic tests, the patient was clinically diagnosed with ovary mucinous adenocarcinoma. Whether gastrointestinal-type chemotherapy or gynecologic chemotherapy was a favourable choice for patients with advanced ovarian mucinous cancer had not been determined. The patient received a chemotherapy regimen based on the histologic characteristics rather than the tumour origin. The patient received nine cycles of FOLFOX and bevacizumab. This was followed by seven cycles of bevacizumab maintenance therapy for 9 mo. Satisfactory therapeutic efficacy was achieved.CONCLUSIONThe genetic analysis might be used in the differential diagnosis of primary ovarian mucinous carcinoma and non-gynecologic mucinous carcinoma. Moreover, primary ovarian mucinous carcinoma patients could benefit from gastrointestinal-type chemotherapy.     

Prognostic value of cytologic peritoneal washings

The following points summarize the important diagnostic and prognostic features of peritoneal cytology. Malignant cells in peritoneal fluid are most often indicative of secondary malignancies with short periods of patient survival except in some early-stage tumors of the female genital tract. Atypical reactive mesothelial cells can simulate malignant cells. Experienced cytologic evaluation is important. Peritoneal cytology is an integral part of the initial staging and follow-up of ovarian cancer. Many researchers feel that peritoneal cytology is important for prognosis in endometrial cancer, and cytologic evaluation is at present a part of some study protocols. There is a low yield of positive peritoneal cytologic findings in patients with early-stage cervical cancer, and cytologic assessment probably plays a small role when other poor prognostic factors are present. Thorough sampling of the peritoneal cavity and careful cytologic preparation are important for optimal diagnosis.