Peritoneal carcinoembryonic antigen level for predicting locoregional and distant spread of gastric cancer.

PURPOSE: Peritoneal recurrence is not an uncommon cause of death after surgery for gastric cancer, even after surgery with curative intent. This indicates that there is undetected residual disease in the peritoneal cavity. We conducted this study to determine the value of peritoneal and serum carcinoembryonic antigen (CEA) levels and peritoneal washing cytology in predicting the locoregional and distant spread of gastric cancer. METHODS: We prospectively evaluated 70 consecutive patients with gastric cancer by measuring peritoneal CEA (pCEA) and serum CEA (sCEA) levels and peritoneal washing cytology results, and studying their effect on the histopathologic properties. The effect of the pCEA level on disease-free survival (DFS) and overall survival (OS) was also evaluated in patients treated with curative intent. RESULTS: Twenty-one (30%) patients had sCEA levels >10 ng/ml, whereas 25 patients (35.7%) had pCEA levels >10 ng/g protein and 26 patients (37.1%) had positive cytology. The pCEA levels were significantly higher in patients with hepatic metastases (P = 0.034), or serosal (P = 0.028), and peritoneal (P = 0.026) involvement, whereas the sCEA levels were significantly higher only in patients with hepatic metastases (P = 0.04). Similarly, positive cytology was mainly detected in patients with hepatic metastases (P = 0.004). The pCEA levels significantly affected DFS (P = 0.002) and OS (P = 0.01) in 34 patients treated with curative intent. CONCLUSION: Since pCEA levels are more useful for predicting locoregional recurrence, their measurement during surgery may help plan the most appropriate surgical strategy and adjuvant therapy.

Frozen section in thyroid surgery: is it a necessity?

INTRODUCTION: Many surgeons use intraoperative frozen-section (FS) biopsy of thyroid nodules to predict malignant disease, but the findings are often not in agreement with those of fine-needle aspiration (FNA) biopsy. Our objective in this study was to assess the value of intraoperative FS biopsy in patients with nodular disease of the thyroid gland. METHODS: In this study, 203 patients underwent thyroid surgery at the Ankara Oncology Hospital. Nodules were assessed by FNA biopsy preoperatively, by FS intraoperatively and by histologic examination of the excised specimen. Sensitivity, specificity and accuracy were determined for FS and FNA with respect to the histologic findings. RESULTS: The sensitivity, specificity and accuracy rates for FNA, excluding occult cancers, were 74.1%, 100% and 95.2%, respectively, and for FS were 87.1%, 100% and 97.8%, respectively. FS influenced operative decisions in 0.6% of nodules found to be benign by FNA and in 20% of nodules found to be suspicious by FNA. FS contributed nothing for FNA-malignant disease since all the results in this group were true positive. CONCLUSIONS: Intraoperative FS was most helpful when the FNA findings were suspicious for malignant disease. FS does not seem to be necessary when FNA indicates malignant or benign disease. Both FNA and FS failed to detect occult thyroid carcinomas.