Diagnostic and prognostic value of peritoneal cytology in biliary tract cancer

Evaluation of peritoneal cytology provides valuable prognostic information in abdominal cancers. The aim of this study is to assess the incidence and the prognostic value of conventional peritoneal cytology in biliary tract cancers.

A total of consecutive 41 patients with biliary cancers (17 bile duct, 20 gallbladder, 4 ampulla of Vater) underwent surgery between July 2003 and July 2005. Peritoneal cytology was performed in these patients at the beginning of laparotomy. On opening the abdomen, 100mL of normal saline were instilled into the subhepatic space and retrieved. Cytologic analysis was performed using the Papanicolau technique.

The overall incidence of positive cytology findings was 9.8% (4/41). When analyzed by disease factors or stage, the prevalence of positive cytology was 0% in T1/T2, 6% in T3, 38% in T4 (p=0.03), 0% in N0, 25% in N1 (p=.03), 3% in M0, 27% in M1 (p=0.02), 0% in Stage I/II and 27% in Stage III/IV cases (p<0.01), respectively. Although survival was worse in patients with positive peritoneal cytology, when adjusting TNM stage the positive peritoneal cytology did not have significant prognostic value.

Peritoneal cytology associates positively with advanced disease but does not increase prognostic information in biliary tract cancers.