Diagnosis Of Malignant Ascites Research Articles

Case Report: A rare presentation of prostate cancer with peritoneal carcinomatosis and malignant ascites complicated by tumor lysis syndrome

Background: Only 32 cases of prostate cancer with peritoneal carcinomatosis and ascites have currently been reported in the literature. We present the first reported case of prostate cancer with peritoneal carcinomatosis and malignant ascites whose treatment was complicated by tumor lysis syndrome along with a literature review evaluating similar cases. Case: We present a rare case of a 78-year-old retired Caucasian male with recurrent metastatic prostate cancer and malignant ascites. He had previously received definitive radiotherapy for localized prostate cancer but presented with bilateral hydronephrosis and right-sided bladder wall thickening 10 years later. He had imaging evidence of locoregional recurrence with elevated prostate specific antigen (PSA) and was initiated on combined androgen blockade with intramuscular leuprolide and oral bicalutamide. After being transferred to Scripps Clinic, he was found to have a solitary right upper lobe pulmonary lesion for which he completed stereotactic body radiation therapy. Then, 10 months later, he developed new onset malignant ascites and was treated with two cycles of intravenous docetaxel. Treatment resulted in improvement in his ascites and reduction in PSA. Unfortunately, his course was complicated by tumor lysis syndrome, encephalopathy, Escherichia coli bacteremia, and a fatal saddle pulmonary embolism. Conclusions: (1) Occurrence of ascites in prostate cancer patients is associated with worse prognosis than non-ascitic variants. (2) More common etiologies of ascites must be evaluated for. (3) Ascitic fluid prostate specific antigen (PSA) measurement may aid in diagnosis of malignant ascites in cases with diagnostic uncertainty. (4) Patients with advanced disease may benefit from combined hormonal and cytotoxic therapies. (5) Awareness of the occurrence of tumor lysis syndrome (TLS) in patients treated for prostate cancer can help identify patients in whom prophylaxis would be beneficial.

Diagnostic Accuracy of Different Computed Tomography Signs for Differentiating Between Malignant and Cirrhotic Ascites Keeping Ascitic Fluid Cytology as Gold Standard.

ObjectiveThe goal of this research was to define the diagnostic precision of CT signs to distinguish malignant ascites from cirrhotic ascites. Ascitic fluid cytology was kept as the gold standard.Study designThis research was a prospective cross-sectional study.Place and duration of the studyParticipants’ recruitment started on July 15, 2021, and the whole study lasted about three months till October 15, 2021, at the Radiology Department of Pakistan Institute of Medical Sciences, Islamabad.Patients and methodsA total of 80 patients were included in the research and divided into two groups grounded on the cirrhotic or malignant etiology of the ascites based on their fluid cytology. Ascites volume, relative spread between the lesser sac and greater peritoneal cavity, the wall thickness of gallbladder, density of ascites, parietal peritoneum thickness and degree of its enhancement, and presence of septa and loculations were some of the major CT signs studied.ResultsThe average age of patients included in this study was 36.2 ± 6.67 years (range 29-49 years). Of the 80 patients, 50 (62.5 %) were men, and 30 (37.5 %) were women. CT signs associated with the malignant ascites reported in this study were fluid present in the lesser sac (p = 0.03), peritoneal thickening and degree of its enhancement (p = 0.05), increased ascites density (p= 0.001), and presence of septa and loculations (63.6 % of malignant ascites). However, gallbladder wall thickness did not show any variation between both groups.ConclusionWe conclude that in the diagnosis of malignant ascites, CT scan imaging can play a vital role. This research approves and testifies the benefits of indirect signs such as the spread of ascites, increased density of ascites, thickening and enhancement of parietal peritoneum, and ascitic fluid complexity in pointing out malignancy as a cause of ascites.

Diffusion-Weighted Magnetic Resonance Imaging as a Noninvasive Parameter for Differentiating Benign and Malignant Intraperitoneal Collections.

Background and Objective: The imaging differentiation of benign from malignant intraperitoneal collections (IPCs) relies on the tumoral morphological modifications of the peritoneum, which are not always advocating for malignancy. We aimed to assess ascitic fluid with the apparent diffusion coefficient (ADC) to determine non-invasive, stand-alone, differentiation criteria for benign and malignant intraperitoneal effusions. Materials and Methods: Sixty-one patients with known IPCs who underwent magnetic resonance examinations for reasons such as tumor staging, undetermined abdominal mass and disease follow up were retrospectively included in this study. All subjects had a final diagnosis of the fluid based on pathological examinations, which were divided into benign (n = 37) and malignant (n = 24) IPCs groups. ADC values were measured separately by two radiologists, and the average values were used for comparing the two groups by consuming the independent samples t-test. The receiver operating characteristic analysis was performed to test the ADC values’ diagnostic ability to distinguish malignant from benign collections. Results: The differentiation between benign and malignant IPCs based on ADC values was statistically significant (p = 0.0034). The mean ADC values were higher for the benign (3.543 × 10−3 mm2/s) than for the malignant group (3.057 × 10−3 mm2/s). The optimum ADC cutoff point for the diagnosis of malignant ascites was <3.241 × 10−3 mm2/s, with a sensitivity of 77.78% and a specificity of 80%. Conclusions: ADC represents a noninvasive and reproducible imaging parameter that may help to assess intraperitoneal collections. Although successful in distinguishing malignant from benign IPCs, further research must be conducted in order to certify if the difference in ADC values is a consequence of the physical characteristics of the ascitic fluids or their appurtenance to a certain histopathological group.

3048 New Onset Ascites Related to Peritoneal Carcinomatosis

INTRODUCTION: Peritoneal carcinomatosis (PC) is a metastatic feature in several gastrointestinal malignancies. As one of the most common presenting symptoms is new onset ascites, understanding the workup and typical findings of malignant ascites is crucial for appropriate and time sensitive diagnosis and treatment of such malignancies. CASE DESCRIPTION/METHODS: A 50-year-old female with past medical history significant for hypertension and alcohol abuse presented to the hospital with complaint of intermittent weakness and progressive abdominal fullness for one month. Her exam was notable for subconjunctival palor, abdominal ascites with generalized tenderness, and lower extremity edema. Labs showed leukocytosis and microcytic anemia, with hemoglobin of 5.9. CT abdomen/pelvis revealed cardiomegaly, moderate volume ascites, and diffuse body wall edema. Iron studies were obtained (low iron, low-normal ferritin) and the patient was transfused. A diagnostic paracentesis was completed with resultant SAAG of 0.6. Cytology revealed benign appearing mesothelial cells and histiocytes. Due to the patient's lack of insurance, GI was consulted for inpatient evaluation of iron deficiency. Colonoscopy showed a large (&gt;10 cm) ulcerated lesion in the sigmoid colon with pathology consistent with moderately-differentiated adenocarcinoma. Repeat CT was obtained for staging purposes, showing diffuse peritoneal carcinomatosis, distal colon lesion, L4 vertebral sclerosis, and large volume ascites. The patient was discharged with plans to follow up with GI and oncology to discuss therapeutic options. DISCUSSION: Peritoneal carcinomatosis is defined as the dissemination of cancer cells throughout the periteoneum. About 8% of patients with colorectal cancer present with PC; most commonly with nonspecific symptoms such as fatigue, abdominal pain/fullness, and bowel obstruction. Since new onset ascites is common to PC, it is important to identify malignant ascitic fluid. Malignant ascites related to peritoneal carcinomatosis is mainly caused by subphrenic vessel obstruction and accounts for 7% of ascites cases. A diagnostic paracentesis is indicated, with typical fluid findings of WBC &gt;500, SAAG &lt;1.1, and total protein &gt;2.5. Fluid cytology is important, however sensitivity is affected by the number and quality of specimens used, making the overall sensitivity only about 60-70%. After a diagnosis of malignant ascites is made, the patient should be counseled and referred for evaluation of available therapeutic options.

Value of ascitic fluid lipids in the differentiation between cirrhotic and malignant ascites

Background: The diagnosis of malignant ascites can be difficult. The overall sensitivity of cytology smears for the detection of malignant ascites is 58%–75%. There is a debate about the role of ascitic fluid lipids and their gradients in the differential diagnosis of ascites. This study aims to evaluate the role of ascitic fluid lipids and their gradients in the differentiation of malignant ascites from cirrhotic ascites. Patients and Methods: Ninety-six patients were enrolled in this study divided into two groups according to the cause of ascites; Group I: included 48 patients with malignant ascites and Group II: included 48 patients with cirrhotic ascites. Results: Ascitic fluid cholesterol, triglycerides, and phospholipids were significantly higher among patients of Group I (77.5 ± 11.5, 82.4 ± 17.04 mg/dl, and 0.92 ± 0.14 mmol/L vs. 27.7 ± 7.5, 56.2 ± 16.2 mg/dl, and 0.33 ± 0.09 mmol/L in succession P

Comparative proteomic analysis of human malignant ascitic fluids for the development of gastric cancer biomarkers

ObjectivesMalignant ascites is a sign of peritoneal seeding, which is one of the most frequent forms of incurable distant metastasis. Because the development of malignant ascites is associated with an extremely poor prognosis, determining whether it resulted from peritoneal seeding has critical clinical implications in diagnosis, choice of treatment, and active surveillance. At present, the molecular characterizations of malignant ascites are especially limited in case of gastric cancer. We aimed to identify malignant ascites-specific proteins that may contribute to the development of alternative methods for diagnosis and therapeutic monitoring and also increase our understanding of the pathophysiology of peritoneal seeding. Design & methodsFirst, comprehensive proteomic strategies were employed to construct an in-depth proteome of ascitic fluids. Label-free quantitative proteomic analysis was subsequently performed to identify candidates that can differentiate between malignant ascitic fluilds of gastric cancer patients from benign ascitic fluids. Finally, two candidate proteins were verified by ELISA in 84 samples with gastric cancer or liver cirrhosis. ResultsComprehensive proteome profiling resulted in the identification of 5347 ascites proteins. Using label-free quantification, we identified 299 proteins that were differentially expressed in ascitic fluids between liver cirrhosis and stage IV gastric cancer patients. In addition, we identified 645 proteins that were significantly expressed in ascitic fluids between liver cirrhosis and gastric cancer patients with peritoneal seeding. Finally, Gastriscin and Periostin that can distinguish malignant ascites from benign ascites were verified by ELISA. ConclusionsThis study identified and verified protein markers that can distinguish malignant ascites with or without peritoneal seeding from benign ascites. Consequently, our results could be a significant resource for gastric cancer research and biomarker discovery in the diagnosis of malignant ascites.

Diagnostic value of DNA quantitative analysis and thinprep cytologic test in diagnosis of malignant pleural effusion and ascites

Objective To discuss the application value of DNA quantitative analysis and thinprep cytologic test for the diagnosis of malignant peritoneal effusion. Methods Fifty-eight cases patients with pleural effusion and ascites in the Second People′s Hospital of Yueyang were involved in this study.DNA quantitative analysis and thinprep cytologic test were conducted for the collected ascites, than compared the sensitivity of that two methods. Results There were 39 cases patients were diagnose malignant tumor by biopsy or pathology, the positive rate of DNA quantitative analysis(92.31%, 36/39) was obviously higher than that of thinprep cytologic test(82.05%, 32/39), the results had no statistical significance(P=0.017). The consistency check kappa value of DNA quantitative analysis and Thinprep cytologic test with pathology diagnosis were 0.807 and 0.498 respectively.The AUC of the combined examination of DNA quantitative analysis and thinprep cytologic test for malignant peritoneal effusion was 0.92, higher than the AUC of DNA quantitative analysis and Thinprep cytologic test single index examinations(0.90, 0.75). The detection sensitivity of DNA quantitative analysis and thinprep cytologic test were 94.74%(36/38) and 84.21%(32/38) respectively, specificity were 85.00%(17/20) and 65.00%(13/20) respectively, the dia were 91.38%(53/58), 77.59%(45/58) respectively, the joint detection sensitivity was 94.87%(37/39), specificity was 95.00%(19/20), the diagnostic accuracy was 93.10%(54/58). Conclusion Compared with thinprep cytologic test, DNA quantitative analysis with high sensitivity and specificity, while the combination of the two methods can greatly improve the accuracy of diagnosis of malignant ascites. Key words: Ascites; DNA quantitative analysis; Thinprep cytologic test

Evaluation of tumor markers for the differential diagnosis of benign and malignant ascites

Introduction. The diagnosis of malignant ascites is a challenging problem in clinical practice, non-invasive techniques should be developed to improve diagnostic accuracy. The diagnostic performances of tumor markers in malignant ascites remained unsettled. Our aim was to evaluate diagnostic performance of tumor markers in differential diagnosis of benign and malignant ascites.Material and methods. A total of 437 patients were enrolled, and the relevant parameters of the patients were analyzed for the differentiation of benign ascites from malignant ascites.Results. At the predetermined cutoff values of tumor makers, tumor markers in ascitic fluid showed better diagnostic performance than those in serum. Combined use of tumor markers and the cytology increased the diagnostic yield of the latter by 37%. In cytologically negative malignant ascites, tumor markers provided assistance in differentiating malignant ascites from benign ascites, and the combination of ascitic tumor markers yielded 86% sensitivity, 97% specificity.Conclusion. Use of a panel of tumor markers exhibited excellent diagnostic performance in diagnosing malignant ascites, which indicated the detection of tumor markers may represent a beneficial adjunct to cytology, thus guiding the selection of patients who might benefit from further invasive procedures.

Clinicopathological characteristics and prognosis of gastric cancer with malignant ascites

Management of gastric cancer with malignant ascites is a challenge, and limited data are available. We evaluated factors affecting survival for this condition to determine factors that predict survival outcome and to develop a rational treatment plan. We retrospectively studied 5,542 patients with gastric adenocarcinoma from January 2007 to December 2012. Among them, 347 patients (6.26%) were associated with malignant ascites. The patients' overall survival was compared among the different features. Three hundred forty-seven patients (153 females and 194 males; median age, 53 years) were enrolled, including 78 (22.5%) young patients and 63 (18.1%) elderly patients. One hundred forty-three (41.2%) patients presented with malignant ascites at the initial diagnosis of gastric cancer, and 211 (60.8%) received chemotherapy. After a median follow-up duration of 10.4 months, the median survival after the diagnosis of malignant ascites was 5.2 months (95% CI, 4.8-5.6 months), and the 1-year survival rate was 16.1 %. An ECOG score greater than 2 (P < 0.001), the presence of ascites with the diagnosis of gastric cancer (P < 0.001), no chemotherapy (P < 0.001), an albumin level less than 30 g/L (P = 0.013), an ascites volume greater than 2,000 mL (P = 0.019), Helicobacter pylori infection (P = 0.010), and metastases to other organs (P = 0.037) were associated with poor prognosis, and they were all independent prognostic factors. The survival of gastric cancer patients with malignant ascites is relatively short, and ECOG score and the presence of ascites with the diagnosis of gastric cancer are the most important prognostic factors. Additionally, chemotherapy could improve the overall survival.

Management of ascites due to gastrointestinal malignancy

Ascites is the pathological accumulation of fluid within the abdominal cavity. The most common cancers associated with ascites are adenocarcinomas of the ovary, breast, colon, stomach and pancreas. Symptoms include abdominal distension, nausea, vomiting, early satiety, dyspnea, lower extremity edema, weight gain and reduced mobility. There are many potential causes of ascites in cancer patients, including peritoneal carcinomatosis, malignant obstruction of draining lymphatics, portal vein thrombosis, elevated portal venous pressure from cirrhosis, congestive heart failure, constrictive pericarditis, nephrotic syndrome and peritoneal infections. Depending on the clinical presentation and expected survival, a diagnostic evaluation is usually indicated as it will impact both prognosis and the treatment approach. Key tests include serum albumin and protein and a simultaneous diagnostic paracentesis, checking ascitic fluid, WBCs, albumin, protein and cytology. Median survival after diagnosis of malignant ascites is in the range of 1 to 4 months; survival is apt to be longer for ovarian and breast cancers if systemic anti-cancer treatments are available.

Clinical value of tumour markers and serum-ascites albumin gradient in diagnosis of malignant ascites

Objective To investigate the clinical value of tumour markers and serum-ascites albumin gradient (SAAG) in diagnosis of malignant ascites. Methods One hundred and fourteen patients with ascites, who were admitted to the hospital between Jan. 2005 and Jan. 2008, were retrospectively reviewed. The patients were divided into malignant (n = 39) or benign (12 with tuberculosis and 93 with aseptic liver cirrhosis) ascites groups according to the etiology. The distribution of tumor markers (CEA, CA19-9 and CA125) and SAAG in both groups were analyzed and receiver operating characteristic (ROC) was constructed. Results The tumor markers and SAAG were found both in malignant ascites group and benign ascites group. The concentrations of CEA and CA19-9 in serum and ascites were higher in malignant ascites group than in benign ascites group. The SAAG in malignant ascites group was significantly lower than that in patients with liver cirrhosis (P 0. 05). There was no difference in level of CA125 in serum or ascites between malignant ascites group and benign ascites group (P>0.05). The area under the curve of ascitic fluid CEA, CA19-9 and SAAG were 0.79, 0.82 and 0.85, respectively. The cutoff values of ascitic fluid CEA, CA19-9 and SAAG were optimally chosen at 1.45 μ/L, 19.50 μ/L and 13. 50 g/L, respectively. The sensitivity and specificity were 66.7% and 78.1% in CEA, 74.4% and 84.8% in CA19-9, as well as 82.9% and 84.6% in SAAG.The combination of ascitic fluid CA19-9 with SAAG could increase the specificity to 97.14%, but decrease the sensitivity to 61.54%. Conclusion It is feasible to achieve optimum combination of biochemical indicators using ROC in differential diagnosis of malignant ascites from benign ascites. Key words: Ascites; Tumor markers; Receiver operating characteristics curve

Survival in Patients with Pancreatic Cancer Following the Diagnosis of Malignant Ascites or Liver Metastases By EUS-FNA

Background: The diagnosis of malignant ascites or liver metastases during EUS staging of pancreatic cancer signifies inoperable malignancy and implies a poor prognosis. However, there are limited data on expected survival following EUS in these patients. The purpose of this study is to report survival for a large cohort of patients with pancreatic cancer following the diagnosis of malignant ascites or liver metastases by EUS-FNA. Methods: A prospectively updated EUS database was searched from June 1998 and March 2008 for all patients in whom EUS-FNA of the liver or ascitic fluid was performed.

Predictors Of Poor Prognosis In Patients With Malignant Ascites: A Prospective Study

Malignant ascites is a manifestation of end stage events in a variety of cancers with significant morbidity and a poor prognosis.This study prospectively evaluated factors predicting poor prognosis in patients with malignant ascites. Clinico-pathologic data of patients with malignant ascites at our institution over a period of 18 months were prospectively analysed. Predictors of poor survival were evaluated and survival compared among different cancer groups. A total of 150 patients (96 females, 54 males) with median age of 63 (19-95) years were studied. The commonest cancer was ovarian. Liver metastases were significantly commoner in the gastrointestinal cancers (P=0.0001). Serial paracentesis was offered to 131, chemotherapy in 89, diuretics in 35, intraperitoneal monoclonal antibody in 6 and 7 patients had drainage at surgery. The median survival after the diagnosis of malignant ascites was 9.2 months. Ovarian cancer and female gender favour longer survival while poor performance status, low serum albumin/serum protein, liver metastases, high serum urea, creatinine and total bilirubin levels adversely affected survival. The independent prognostic factors for survival were poor performance status, cancer type, liver metastases, low serum albumin and high urea levels. The cancer type and performance status sig- nificantly influence the choice of treatment option.

Endoscopic Ultrasound–Guided Fine-Needle Aspiration of Ascites

The aim of this study is to report a large single-center experience with endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of ascites. Consecutive patients at our institution in whom EUS-guided paracentesis was performed between January 1997 and July 2005 were identified retrospectively. All procedures were performed by or under the supervision of 1 of 5 experienced endosonographers with available on-site cytopathology. Sixty consecutive patients (33 men; mean age, 67 y) were identified. Previously attempted percutaneous paracentesis was unsuccessful in 3 of 6 patients. Ascites confirmed by EUS FNA was visible in 28 of 54 (52%) computerized tomography, 3 of 11 (27%) transabdominal ultrasound, and 4 of 8 (50%) magnetic resonance imaging examinations before EUS. Transgastric (n = 55) or transduodenal (n = 5) EUS-guided paracentesis (mean, 8.9; range, 1-40 mL) revealed malignancy in 16 (27%) from primary pancreatic (n = 9), gastric (n = 2), urothelial (n = 1), esophageal (n = 1), gallbladder (n = 1), bile duct (n = 1) cancer, and lymphoma (n = 1). The cytology from 2 patients was atypical (1 suspicious for malignancy and 1 considered reactive) and the remaining 42 were benign. Potential complications occurred in 2 of 60 (3%) patients with self-limited fever. Of the 8 of 60 (13%) patients who underwent subsequent surgery, 3 had metastatic pancreatic adenocarcinoma (n = 2) and metastatic small intestinal carcinoid (n = 1) to the peritoneum after negative EUS-FNA cytology. EUS frequently identifies ascites missed by other imaging studies. EUS-guided paracentesis may identify malignancy in a subset of patients. Negative ascitic fluid cytology from EUS FNA does not exclude possible peritoneal carcinomatosis.

Telomerase activity in tuberculous peritonitis and malignant ascites

AIM: To determine telomerase activity of exfoliated cells in tuberculous peritonitis and malignant ascites, and study the diagnostic value of telomerase activity in differentiating tuberculous peritonitis from malignant ascites. METHODS: TRAP-PCR-ELISA and TRAP-PCR-silver staining were employed to determine telomerase activity in 18 specimens of malignant ascites and 13 specimens of tuberculous peritonitis. Telomerase activities in tuberculous peritonitis and malignant ascites were analysed. RESULTS: Telomerase activity in malignant ascites (0.387±0.023) was significantly higher than that in tuberculous peritonitis (0.023±0.004, P <0.01). The positive rate of telomerase activity in malignant ascites was significantly higher than that in tuberculous peritonitis, 88.9 % (16/18) vs 7.7 % (1/13), P <0.01. The sensitivity, specificity and accuracy of determination of telomerase activity in diagnosis of malignant ascites were 88.9 %, 92.3 %, and 90.3 %, respectively. CONCLUSION: Telomerase activity is positive in malignant ascites and may serve as a useful indicator for differentiating between tuberculous peritonitis and malignant ascites.

Diagnostic Importance of Ascitic Fluid Cholesterol Level in the Diagnosis of Malignant Ascites

In order to evaluate the diagnostic accuracy of cholesterol level in ascites, we studied 27 patients with non-complicated sterile ascites (group l), 12 patients with spontaneous bacterial peritonitis (group ll), and 17 patients with malignant ascites (group lll). The median cholesterol level in ascitic fluid was 0.44 mmol/L (lQR 0.62) in group l, 0.25 mmol/L (lQR 0.95) in group ll, and 2.61 mmol/L (lQR 2.66) in group lll. The ascitic fluid cholesterol level was significantly higher in malignant ascites than sterile benign ascites and spontaneous bacterial peritonitis (SBP) (P

Fibrinolytic changes in malignant ascites

Fibrinolytic activity and inhibitory activity was measured in 36 malignant ascites and 20 cirrhotic ascites using euglobulin fibrinolytic activity, fibrin autography, reverse fibrin autography and quantitation of tissue-type plasminogen activator (t-PA), urokinase-type plasminogen activator (u-PA) and plasminogen activator inhibitor type-1 (PAI-1) antigen by ELISA method. Fibrin autography demonstrated fibrinolytic bands at Mr of 100 kD, 70 kD, 62 kD and 55 kD. The 70 kD band was the predominant one. Reverse fibrin autography showed a single fibrinolysis-resistant band at Mr of 40 kD. t-PA was the predominant fibrinolytic protein in ascites and its concentration was 1.5 to 2 times that in plasma (p<0.005). u-PA, t-PA and PAI-1 antigen concentrations were significantly increased in malignant ascites over cirrhotic ascites (p<0.001, p<0.001, p<0.0001). However, the difference in euglobulin fibrinolytic activities was not statistically significant between the two groups. The sensitivity, specificity and accuracy of PAI-1 antigen at the cut-off point of>4.5 ng/ml in diagnosis of malignant ascites were comparable or better to conventional parameters, but those of t-PA antigen and u-PA antigen were not. In conclusion, we observed that fibrinolytic profiles in malignant ascites differ from those in cirrhotic ascites and measurement of PAI-1ag, could be helpful to differentiate malignant and benign ascites.

Diagnostic accuracy of sialic acid in the diagnosis of malignant ascites.

The authors evaluated the diagnostic accuracy of sialic acid and its lipid-bound fraction in ascites and compared these tests with others (fibronectin, cholesterol) recently claimed as valuable in the differential diagnosis of ascites. Fibronectin yielded the best diagnostic accuracy (85%) with no false-positive and 37% of false-negative (10/27). The authors also found higher concentration of sialic acid in malignant ascites than in nonmalignant ascites (P less than 0.001) and, taking 300 mg/l as the cutoff value, the false-positive rate was 10% (four of 40), the false-negative rate 30% (eight of 27), and the overall diagnostic accuracy 82%, comparable to that of the fibronectin. The authors conclude that both fibronectin and sialic acid determinations in ascites may be regarded as accurate markers of neoplastic involvement of the peritoneum, although no test is useful in the ascites with hepatocellular carcinoma and cirrhosis of the liver.

Flow cytometry. A new technique in the diagnosis of malignant ascites.

The diagnosis of peritoneal carcinomatosis is often dependent on the finding of malignant cells in ascitic fluid analysis by a trained cytologist. Other methods are needed to increase the current diagnostic yield of 60-90%. Abnormal DNA content is characteristic of most malignancies. In an attempt to detect aneuploidy, we used high-resolution DNA histogram analysis with fluorescent DNA-specific stains and flow cytometry to evaluate 33 ascitic fluid samples. Of 13 patients with malignant ascites, aneuploidy was demonstrated in 10. Six patients with proven peritoneal carcinomatosis and normal cytologic examination had abnormal DNA histograms. DNA quantitation and cytologic examination agreed in 24 of 33 cases. These findings suggest that flow cytometry is a rapid and useful technique in the diagnosis of malignant ascites. The presence of aneuploidy in cells from ascitic fluid is highly suspicious for peritoneal carcinomatosis and suggests the need for further evaluation for malignancy.