Value of carcinoembryonic antigen (CEA) and cholesterol assays of ascitic fluid in cases of inconclusive cytology

Abstract

Aim-To determine whether assays of carcinoembryonic antigen (CEA) and cholesterol in ascites add diagnostic value to cytology. Methods-The additional diagnostic eYcacy of the biochemical assays was studied in the ascitic fluid from 130 patients, of whom 57 had peritoneal carcinomatosis. All diagnoses were verified by subsequent necropsy and/or histology. Results-CEA concentrations over 5 ng/ ml indicated carcinomas, occasionally without peritoneal involvement of the tumour. However, increased values were significantly more common in cancer with peritoneal involvement (p < 0.01), giving a sensitivity of 51% and specificity of 97% for carcinomatosis. A cholesterol value exceeding 1.21 mmol/litre was found in 93% of cancers with peritoneal involvement, but it was not entirely specific (96%) for carcinomatosis. Simultaneous increases in CEA and cholesterol concentrations were specific for carcinomatosis and this combination increased the sensitivity for diagnosing carcinomatosis from 77% with cytology alone to 88%. The correct diagnosis could thus be made in five of 12 cases with inconclusive cytology. Conclusions-The measurements of both CEA and cholesterol concentrations in ascites give additional specific information about peritoneal carcinomatosis and can therefore be a useful adjunct to cytology-in particular, in inconclusive cases. (J Clin Pathol 2001;54:831-835) Keywords: ascitic fluid; carcinoembryonic antigen; cholesterol; cytology Conventional cytological examination of ascitic fluid often yields inconclusive results: apart from benign and malignant diagnoses, many cases are "suspicious for malignancy". [1][2][3] In liver cirrhosis, inflammation, chemotherapy, and irradiation it is often diYcult to distinguish exfoliated reactive mesothelial cells from highly diVerentiated cancer cells. Moreover, the cytology is often false negative because only a few neoplastic cells are present in the fluid, 4 or processing of specimens is suboptimal with lysis of tumour cells. 5 Therefore, a specific cytological diagnosis may have a sensitivity of only 40-80%. [6][7][8] Samples that are inconclusive because of some cellular atypia can be further evaluated with ancillary morphological methods, such as immunocytochemistry 1-3 9 and DNA cytometry, 2 9 10 although these techniques are of little help when only a few preserved tumour cells are present.Biochemical parameters, such as the concentrations of carcinoembryonic antigen (CEA) 6-8 10-12 and cholesterol 4 12-15 in the serous eVusion, have been studied as markers of malignancy. Such assays can be done rapidly in properly preserved eVusions after cytological examination, but their diagnostic value is still debated. It has therefore been stated that the cholesterol content of ascitic fluid is neither specific nor sensitive for a tumour.5 16 Some authors have suggested that a high concentration of CEA in the ascitic fluid is indicative of peritoneal metastases from a CEA producing tumour, 7 12 although it has been found in carcinomas without serosal involvement....

Correlation of Tumour Markers in Ascitic Fluid and Serum: Are Measurements of Ascitic Tumour Markers a Futile Attempt?

“…In fact some studies have concluded that the measurement of ascitic tumour markers does not improve the discriminative ability of malignant effusions. 7,8,15,20 Nevertheless, the present study found that AFP levels were higher in serum than in ascitic fluid and this agrees with the view that AFP levels are always higher in serum than in ascites and are much more sensitive than ascitic cytology in detecting hepatocellular carcinoma. 2 Benign diseases, especially liver cirrhosis, tuberculous peritonitis or nephrotic syndrome have also been the focus for ascitic fluid tumour marker analysis.…”

“…14 Several tumour markers in ascitic fluid, for example CEA, CA125, CA19.9 and CYFRA, have been assessed as potential diagnostic tools in malign or benign ascites, especially in situations where cytological examinations are insufficient. 5,6,15 In clinical practice, it has been assumed that tumour markers are released from tumour cells that invade the peritoneum and, therefore, it might be assumed that the levels of tumour markers in ascitic fluid could be used for diagnostic purposes. The present study aimed to evaluate this approach by investigating the correlations of tumour markers in ascitic fluid and serum.…”

Clinical Evaluation of the Simultaneous Determination of Tumor Markers in Fluid and Serum and Their Ratio in the Differential Diagnosis of Serous Effusions

“…1). The use of a high cut-off as well as the finding of higher concentrations in fluid than in serum is the only useful methods to discriminate fluid origin with these tumor markers [10,19].…”

Peritoneal mucinous cystadenocarcinoma of probable urachal origin: a challenging diagnosis

“…10 A repeat computer tomography three months after laparotomy showed thickening of the anterior bladder wall (2.5 cm) with cystic changes. The patient has unfortunately not taken urological referral for partial cystectomy.…”