THE APPLICATION OF FLOW CYTOMETRIC DNA ANALYSIS IN DETECTING THE PRESENCE OF MALIGNANT-CELLS IN OVARIAN-CARCINOMA PERITONEAL FLUIDS

Objective To compare flow cytometric detection of malignant cells with standard cytological evaluation in patients with ovarian carcinoma. S etting The City Hospital Trust, The Women's Hospital and CRC Trials Un it, Birmingham. Subjects Forty-three patients with histologically prov en ovarian carcinoma and positive cytology, and a control population o f 20 patients undergoing surgery for benign gynaecological conditions. Methods Prospective, blinded study examining ascitic fluid or periton eal washings obtained at primary surgery by flow cytometric DNA analys is and cytological examination. Results Flow cytometry detected aneupl oid cells in 27/43 (63%) of malignant and 7/20 (35%) of benign fluid s pecimens. In malignant samples the mean aneuploid count was 38.5% (ran ge 1-98%) with a mean S-phase fraction of 5.2% (range 0-33.9%). In ben ign specimens the mean aneuploid count was 30.4% (range 14.5-66.4%). B ased on these results, the overall sensitivity of cytometric detection of malignant cells was 71.4%, specificity 65%, with a positive predic tive value of 85.1%. False positivity was found mainly in patients wit h benign ovarian cysts. Further examination revealed four false negati ve and four false positive results, where the peritoneal fluid and ova rian tissue DNA ploidy status concurred. Assuming such results to be c orrect increased the sensitivity of the test to 88.5% and specificity to 85%. Conclusions Although flow cytometry can glean information beyo nd the capabilities of cytological assessment, using the premise that aneuploid cells alone indicate malignancy, it remains secondary to cyt ology in the detection of malignant cells in peritoneal fluids.