Abstract
Background
Staging laparoscopy with peritoneal cytology and biopsies is recommended in selected patients with gastric cancer (GC), but practical guidance for assessment of peritoneal lavage/ascites and peritoneal biopsies is lacking. We aimed to develop consensus-based recommendations for handling, assessing and reporting of these specimens.Methods
A modified Delphi study was conducted among Dutch experts in GC (cyto)pathology. In round 1, sixty-two statements on clinical information, specimen requirements, initial assessment, ancillary testing, biomarker testing and reporting were rated on a 3-point scale (agree/neutral/disagree); consensus was predefined as ≥ 80% agreement. Non-consensus statements were discussed in an online meeting, informed by comments and literature review, revised, and re-rated in Round 2 on a dichotomous agree/disagree scale, with consensus defined as ≥ 70% agreement.Results
Thirty-one experts from university, general, and independent pathology practices participated. Consensus was achieved for 39 of 62 statements (63%) in Round 1 and for 58 of 62 statements (94%) after Round 2. Consensus was achieved on required clinical information from surgeons, specimen submission and handling, cytological and histological assessment, use of ancillary immunocytochemistry/immunohistochemistry, structured reporting categories, and approaches to biomarker testing on peritoneal biopsies. The study also resulted in structured reporting templates for peritoneal cytology and biopsies.Conclusion
This Delphi study achieved broad expert consensus on pathological assessment of peritoneal fluid and biopsies obtained during staging laparoscopy in GC patients. The resulting recommendations and structured reporting templates provide a practical framework to harmonise specimen handling, evaluation and reporting, thereby promoting greater standardisation and consistency in GC staging.