Abstract
The ascitic fluid concentrations of cholesterol and fibronectin and the serum-ascites albumin difference were compared with two conventional tests of ascitic fluid, total protein and LDH, in their diagnostic ability for detection of malignancy in ascitic samples from 69 patients with ascites: 54 with ascites due to liver disease and 15 whose ascites was caused by peritoneal metastases. Sixteen cirrhotic patients with superimposed hepatocellular carcinoma in whom ascites was of uncertain etiology were considered separately. The mean ascitic fluid total protein, LDH, cholesterol, and fibronectin values in the peritoneal metastases group were 3.70±1.20 g/dl, 247.26±148.14 units/liter, 109. 06±29.85 mg/dl, and 91.57±41.52 μg/ml, respectively, and all were significantly higher than the corresponding values in the liver disease group (P<0.001), which were 1.37±0.59 g/dl, 75.40±110.70 units/liter, 23.75±11.22 mg/dl, and 31.86±10.51 μg/ml,respectively. Mean serum-ascites albumin difference in the peritoneal metastases group was 0.62±0.38 g/dl, which was significantly different from the corresponding value in the liver disease group (1.92±0.41 g/dl, P <0.001). Both ascitic cholesterol above 46 mg/dl and an ascitic fibronectin concentration >50 μg/mlhad high diagnostic accuracy (97%) for malignancy, being higher than that achieved using a serum-ascites albumin difference under 1.1 g/dl and an ascitic total protein above 2.5 g/dl, which had accuracies of 94% and 93%, respectively. Ascitic fluid LDH was the least reliable test. No differences in the ascitic fluid analysis were found between cirrhotic patients with and without hepatocellular carcinoma. We conclude that both ascitic cholesterol and ascitic fibronectin are clinically more accurate than the serum-ascites albumin difference, ascitic total protein,and ascitic LDH in the diagnosis of malignant ascites. Of these tests, the determination of ascitic cholesterol may be the preferred one because of its simplicity and cost effectiveness.
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References
Conn HO: The diagnosis and examination of ascitic fluid.In Diagnostic Procedures in the Evaluation of Hepatic Diseases. S Beker (ed). New York, Alan R. Liss, 1983, pp 529–565
Foot NC: The identification of neoplastic cells in serous effusions. Critical analysis of smears from 2029 persons. Am J Pathol 32:961–977, 1956
Sampliner RE, Iber FL: High protein ascites in patients with uncomplicated hepatic cirrhosis. Am J Med Sci 267:275–279, 1974
Boyer TD, Kahn AM, Reynolds TB: Diagnostic value of ascitic fluid lactic dehydrogenase, protein and WBC levels. Arch Intern Med 138:1103–1105, 1978
Nystrom JS, Dyce B, Wada J, Bateman JR, Haverback B: Carcinoembryonic antigen titers on effusion fluid. Arch Intern Med 137:875–879, 1977
Lowenstein MS, Rittgers RA, Feinerman AE, Kupchik HZ, Marcel BR, Koff RS, Zamcheck N: Carcinoembryonic antigen assay of ascites and detection of malignancy. Ann Intern Med 88:635–638, 1978
García-Tsao G, Conn HO, Lerner E: The diagnosis of bacterial peritonitis: Comparison of pH, lactate concentration and leukocyte count. Hepatology 5:91–96, 1985
Yang C, Liaw Y, Chu C, Sheen I: White count, pH and lactate in ascites in the diagnosis of spontaneous bacterial peritonitis. Hepatology 5:85–90, 1985
Polak M, Torres AC: Diagnostic value of the estimation of glucose in ascitic fluid. Digestion 8:347–352, 1973
Paré P, Talbot J, Hoefs JC: Serum-ascites albumin concentration gradient: A physiologic approach to the differential diagnosis of ascites. Gastroenterology 85:240–244, 1983
Rector WG, Reynolds TB: Superiority of the serum-ascites albumin difference over the ascites total protein concentration in separation of “transudative” and “exudative” ascites. Am J Med 77:83–85, 1984
Schölmerich J, Volk BA, Köttgen E, Ehlers S, Gerok W: Fibronectin concentration in ascites differentiates between malignant and nonmalignant ascites. Gastroenterology 87:1160–1164, 1984
Deverbizier G, Beauchant M, Chapron A, Touchard G, Reiss D: Fibronectin, a marker for malignant ascites. Lancet 2:1104, 1984
Hafter R, Klaubert W, Gollwitzer R, von Hugo R, Graeff H: Cross-linked fibrin derivatives and fibronectin in ascitic fluid from patients with ovarian cancer compared to ascitic fluid in liver cirrhosis. Thromb Res 35:53–64, 1984
Jungst D, Gerbes AL, Martin R, Paumgartner G: Value of ascitic lipids in the differentiation between cirrhotic and malignant ascites. Hepatology 6:239–243, 1986
Lowry OH, Rosebrough NJ, Farr AL, Randall RJ: Protein measurement with the Folin phenol reagent. J Biol Chem 193:265–275, 1951
Gómez-Lechón MJ, Castell JV: Measurement of fibronectin in human body fluids. J Clin Chem Clin Biochem 24:333–339, 1986
Gómez-Lechón MJ, Castell JV: Enzyme-linked immunosorbent assay to quantify fibronectin. Anal Biochem 145:1–8, 1985
Sox HC Jr: Diagnosic decision: Probability theory in the use of diagnostic tests. Ann Intern Med 104:60–66, 1986
Gerbes AL, Klaubert W, Jungst D, Paumgartner G: Comparison of ascitic cholesterol and fibronectin in the differential diagnosis of ascites. J Hepatol Suppl 2:S239, 1985 (abstract)
Torres-Salinas M, Bruguera M, Cabrera J, Ballesta A, Rodés J: Characteristics of ascitic fluid in liver cirrhosis and hepatocellular carcinoma. Gastroenterol Hepatol 2:178–181, 1979
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Prieto, M., Gómez-Lechón, M.J., Hoyos, M. et al. Diagnosis of malignant ascites. Digest Dis Sci 33, 833–838 (1988). https://doi.org/10.1007/BF01550972
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DOI: https://doi.org/10.1007/BF01550972