Carcinogenesis, Teratogenesis & Mutagenesis ›› 2025, Vol. 37 ›› Issue (3): 228-233,251.doi: 10.3969/j.issn.1004-616x.2025.03.009

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Efficacy of cytopathological examination using serous effusion in the diagnosis of high-grade ovarian serous carcinoma

CUI Ying1, ZHAO Linlin1, YU Jing2, ZHAO Huan1, ZHANG Zhihui1, GUO Huiqin1,2   

  1. 1. Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021;
    2. Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Langfang Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Langfang 065001, Hebei, China
  • Received:2025-01-24 Revised:2025-03-28 Published:2025-06-13

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Abstract: OBJECTIVE： This study evaluated the concordance between immunocytochemistry(ICC) of PAX8，WT-1，p53 and p16 in effusion sample and immunohistochemistry (IHC) of primary ovarian tumors； assessed the diagnostic ability of the markers for diagnosing high-grade serous ovarian cancer(HGSOC)； and developed specific criteria for effusion cytology. METHODS： This study included 128 patients with effusion cytology diagnosed as adenocarcinoma and histopathologically confirmed for stage III-IV HGSOC. PAX8，WT-1 positivity，and p53 mutation status were conducted as diagnostic criteria for HGSOC. The Kappa test assessed the concordance between PAX8， WT-1， p53， and p16 expression in serous effusion samples and primary ovarian tumors. The number of definitively classified cases was recorded. RESULTS： The concordance rate of PAX8 expression between effusion and primary sites was 98.31%，with a Kappa value of 0.944 (P<0.05). For WT-1，the concordance rate was 84.43% and the Kappa value was 0.783 (P<0.05). The concordance rates for p53 and p16 were 71.9% and 73.33%，respectively，with corresponding Kappa values of 0.547 and 0.478 (P< 0.05). When using PAX8 positivity，WT-1 positivity，and p53 abnormal expression as diagnostic criteria，the diagnostic rate for HGSOC was 67.97%. Lowering the threshold for p53 overexpression in effusion samples from 70% to 60% enabled the identification of 13 additional cases， increasing the diagnostic rate to 78.13% . Furthermore， combining PAX8 positivity， WT-1 positivity， p53 wild type (with a 60% overexpression threshold)，and diffuse strong p16 positivity with high-grade morphological features of tumor cells raised the diagnostic rate for HGSOC in serous cavity effusion to 85.94%. CONCLUSION： The expression patterns of PAX8 and WT-1 in effusion samples were found to be consistent with those in primary ovarian tumors， whereas expression of p53 and p16 showed only moderate consistency. By lowering the positivity threshold for p53 overexpression from 70% to 60% ， the diagnostic criteria of PAX8 positivity， WT-1 positivity， p53 abnormal expression enhanced the detection rate of HGSOC in effusion cytopathology. Additionally，when p53 was wild-type but PAX8-positive/WT-1-positive/p16 diffusely positive，coupled with high-grade morphological features of tumor cells，the diagnosis of HGSOC was better indicated.

Key words: high-grade serous ovarian cancer, serous cavity effusion, cytopathology, ovarian cancer, immunocytochemistry

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