Efficacy of Peritoneal Cytological Imprinting in Deciding When to Stop Scheduled Peritoneal Lavages

Abstract

Introduction: The lack of a pre-established parameter that allows determining the precise moment to suspend the scheduled peritoneal lavages, often leads to performing insufficient number of them, or perhaps these are unnecessarily prolonged, increasing the probability of the patient´s death.

Objective: To determine the efficacy of peritoneal cytological imprinting in deciding when to stop scheduled peritoneal lavages.

Methods: A descriptive study of diagnostic accuracy was carried out, in a series of cases, with prospective data collection in the five-year period from 2010 to 2014 at Celia Sánchez Manduley Provincial Clinical-Surgical Teaching Hospital. The sample was made up of 42 patients who were treated for persistent secondary peritonitis. They were classified according to four correlation categories, taking paraffin biopsy as reference standard.

Results: Samples with acute peritoneal inflammation and healing of peritoneal inflammation were correctly identified in 39/42 cases. Therefore, the global predictive percentage of the cytological imprint was 92.86%. The sensitivity in the diagnosis of acute peritoneal inflammation was 100%, the specificity was 92.68%, the positive predictive value was 24.99%, and the negative predictive value was 100%. The positive and negative likelihood ratios were 13.67 and 0, respectively. Cohen's kappa coefficient (κ) was 0.376.

Conclusions: The peritoneal cytological imprint is an effective diagnostic method to rule out acute peritoneal inflammation when the result is negative and it was considered very useful to stop scheduled peritoneal lavages.

Keywords: peritoneal cytological imprint; diagnostic efficacy; scheduled peritoneal lavage.