SECONDARY PERICARDIAL MALIGNANCIES - A CRITICAL-APPRAISAL OF THE ROLEOF CYTOLOGY, PERICARDIAL BIOPSY, AND DNA-PLOIDY ANALYSIS

The authors studied 112 pericardial fluids (45 malignant, and 67 benig n) from 63 men and 33 women. All cytologic (n = 112) and histologic (n = 61) specimens were reviewed, Statistical analysis was conducted in 61 paired cytology and histology specimens (45 malignant and 16 benign ) and correlated with available ploidy analysis of fluid specimens (n = 34), In cases of malignancy (41 patients), the primary site was know n in 34 patients, whereas no origin for metastatic disease was apparen t in 3 patients, Pericardial cytology yielded the initial diagnosis in four patients. After careful review of all cytology and histology spe cimens, seven truly discrepant cases were noted, six of which had posi tive cytology, Tissue biopsy sampling error was the cause for such dis crepancies. DNA diploidy obtained by flow cytometry correlated with be nign cytology, whereas aneuploidy was associated with malignant cytolo gy in a total of 32 of 34 cases (94%). Cytologically malignant effusio ns rendered diploid DNA in 2 of 10 cases (20%). In conclusion, cytolog y is the single most important parameter in the evaluation of secondar y pericardial malignancy and should be considered the gold standard. C auses for false-negative cytologic diagnoses include scant cellularity and obscuring blood, Hence, careful screening is recommended. The low sensitivity of flow cytometric DNA analysis does not favor its routin e use.