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Related Experiment Video

Updated: Feb 7, 2026

Neutrophil Extracellular Traps Generated by Low Density Neutrophils Obtained from Peritoneal Lavage Fluid Mediate Tumor Cell Growth and Attachment
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Diagnostic algorithm for determining primary tumor sites using peritoneal fluid.

Cheol Keun Park1,2, Douglas P Malinowski3, Nam Hoon Cho1

  • 1Department of Pathology, Severance hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Plos One
|July 20, 2018
PubMed
Summary

A new algorithm using 3D cluster patterns and immunocytochemistry (ICC) for CK7 and PAX8 markers helps identify tumor origins in ascites fluid. This method aids in diagnosing unknown primary cancers, improving patient care.

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Area of Science:

  • Oncology
  • Cytopathology
  • Biomarker Discovery

Background:

  • Determining the primary origin of metastatic tumors is crucial for effective treatment.
  • Ascites fluid cytology is often used for diagnosis, but identifying the primary tumor can be challenging.

Purpose of the Study:

  • To develop and validate a novel algorithm for identifying the primary tumor origin using cytological features and immunocytochemistry (ICC) in ascites fluid.
  • To assess the diagnostic performance of the algorithm in differentiating common cancer types.

Main Methods:

  • Liquid-based cytology (LBC) using SurePathTM technology was applied to 96 peritoneal fluid samples from cancer patients and 10 controls.
  • Dual ICC staining for cytokeratin 7 (CK7) and paired box gene 8 (PAX8) was performed.
  • An algorithm integrating 3D cluster patterns and ICC results was developed and analyzed using receiver operating characteristic (ROC) curve analysis.

Main Results:

  • The algorithm successfully differentiated primary origins, including stomach, ovarian, pancreatobiliary, lung, breast, and colon cancers.
  • Distinct patterns were observed: stomach cancer (no 3D cluster/CK7+/PAX8-), ovarian cancer (large 3D cluster/CK7+/PAX8+), and pancreatobiliary cancer (small 3D cluster/CK7+/PAX8-).
  • High areas under the curve (AUC) were achieved, with ovarian cancer showing an AUC of 0.9812 and lung cancer an AUC of 0.882.

Conclusions:

  • SurePathTM technology combined with 3D cluster analysis and dual ICC for CK7/PAX8 provides valuable information for determining the primary origin of unknown carcinomas in ascites fluid.
  • This approach can significantly aid in the clinical management of patients with malignancies of unknown primary origin.