Ascitic fluid analysis for the differentiation of malignancy-related and nonmalignant ascites. Proposal of a diagnostic sequence

Abstract

The authors tried to differentiate malignancy-related from nonmalignant ascites with a sequence of sensitive followed by specific ascitic-fluid parameters. There were four results of this study. First, of nine parameters investigated in a first series of 48 patients, 28 with nonmalignant and 20 with malignancy-related ascites, ascitic-fluid cholesterol and fibronectin yielded the best negative predictive value of 92% each, Carcinoembryonic antigen (CEA) and cytologic examination both showed a positive predictive value of 100%. Second, combining cytologic examination (sensitivity, 70%) and CEA determination (sensitivity, 45%) increased the sensitivity to 80%. Third, cytologic findings were negative in all ascitic-fluid samples with a cholesterol concentration below the cutoff value of 45 mg/100 ml. Fourth, based on the results of the first series of 48 patients, the diagnostic sequence with cholesterol as a sensitive parameter, followed by the combination of cytologic examination and CEA determination as specific parameters, was tested in a second series of 71 patients, 37 with nonmalignant and 34 with malignancy-related ascites. Again cytologic examination was negative in all samples with cholesterol levels below 45 mg/100 ml. In the total of 119 patients, this diagnostic sequence did not identify 9% of patients with malignancy-related ascites, and 82% of samples classified as malignancy related by cholesterol levels above 45 mg/100 ml were confirmed by positive cytologic examination and/or CEA level above 2.5 ng/ml. Thus, a diagnostic sequence with ascitic-fluid cholesterol determination, followed by cytologic examination and CEA determination, in samples with cholesterol levels above 45 mg/100 ml should permit a cost-efficient routine differentiation of malignancy-related from nonmalignant ascites. Cancer 68: 1808-1814,1991. HE DIFFERENTIATION between malignancy-related T (MRA) and nonmalignant ascites (NMA) is important for further diagnostic and therapeutic procedures. Several components of ascitic fluid were tested for their

To Study the Usefulness of Serum and Ascitic Fluid C-Reactive Protein (Crp) and Ascitic Fluid Cholesterol Level in Differential Diagnosis of Malignant, Nonmalignant and Tubercular Ascites

“…To increase diagnostic sensitivity, cytologic evaluation has been coupled with the analysis in serum and ascitic fluid for total protein, various enzymes, fibronectin, tumour antigens, and lipids. 2,8,9 Despite the availability of all above factors, differential diagnosis of ascites is a common clinical problem and is usually done by serum ascites albumin-gradient (SAAG). 10 CRP stands for c-reactive protein it is classical member of pentraxin family.…”

Tumor-associated antigens in effusions of malignant and benign origin

“…Improvements in this sensitivity level have been attempted by the additional determination of different parameters in effused fluids, such as the total protein content [13], the concentration of lactate dehydrogenase [12,28] or cholesterol [6], DNA aneuploidea [25], and immunocytochemical staining of cellular antigens [17,21]. Recently the possibility of discriminating between malignant and benign effusions by the determination of their I 10 20 30 40 50 60 70 80 90 I00 e Palieatm (%1…”

Value of combined detection of AFU and TCH in differential diagnosis between malignant and non-tuberculous benign ascites

“…Therefore, complete separation between malignant ascites and nonmalignant ascites has not been always possible. To increase diagnostic efficiency, cytologic evaluation has been coupled with the analysis in both serum and ascitic fluid for total protein [10,11], various enzymes [9], fibronectin [11,12], tumor antigens [13,14], and lipids [15][16][17], etc.…”