DOI: http://dx.doi.org/10.18203/2349-3933.ijam20181077

Study the usefulness of ascitic fluid cholesterol level in diagnosis of malignant related ascites

. Mayank, B. P. Priyadarshi, Mahendra Singh, Ashok Kumar Verma, Tanu Midha

Abstract


Background: The differential diagnosis of ascites is a common clinical problem. However, the capability to distinguish malignant from non-malignant causes of ascites using available biochemical techniques would obviate many expensive and time-consuming diagnostic studies on patients presenting with ascites of unknown etiology. Therefore, this study was planned to evaluate usefulness of ascitic fluid cholesterol level in diagnosis of malignant ascites.

Methods: Author conducted an observational study in 80 patients, those admitted and willing to give consent in the department of Medicine, LLR and Associated Hospitals, GSVM Medical College, Kanpur from December 2015 to October 2017. All patient underwent full investigations to make the diagnosis of ascites malignant (20) and non-malignant (n=54), tubercular (7) and non-tubercular (47) groups. Six patients were excluded because the ascitic fluid analysis was suggestive of bacterial peritonitis. The data was processed in MS Excel and analysis was carried out using SPSS (23th version).

Results: Author found that the mean value of ascitic fluid cholesterol in malignant group was 100.85+34.28 vs 6.7+2.5 in non-malignant group (p value <0.01) and the mean value of ascitic fluid cholesterol in malignant group was 100.80+34.28 vs 32.43+15.7 in tubercular group, so ascitic fluid cholesterol is highly specific (100%) and sensitive (65%) at cut off value of 100mg/dl in differentiating benign and malignant cause of ascites.

Conclusions: Ascitic fluid cholesterol having high specificity, can be used for differentiating between non-malignant and malignant ascites. It can also be used to differentiate tubercular ascites from malignant ascites.


Keywords


Ascites, Malignant, Non-tubercular and ascitic fluid cholesterol, Non-malignant, Tubercular

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References


Garg R, Sood A, Arora S, Bhatia KL, Chawla AS, Gupta R, et al. Ascitic fluid cholesterol in differential diagnosis of ascites. J Assoc Physicians India. 1993;41:644-6.

Rana SV, Babu SG, Kocchar R. Usefulness of ascitic fluid cholesterol as a marker for malignant ascites. Med Sci Monit. 2005;11:CR136-42.

Zhang H, Li F, Wei Q, Zhu YF. Value of combined detection of AFU and TCH in differential diagnosis between malignant and non-tuberculous benign ascites. Med Oncol. 2011;28:S670-4.

Liu F, Kong X, Dou Q, Ye J, Xu D, Shang H, et al. Evaluation of tumor markers for the differential diagnosis of benign and malignant ascites. Ann Hepatol. 2014;13:357-63.

Cheng D, Liang B, Kong H. Clinical significance of vascular endothelial growth factor and endostatin levels in the differential diagnosis of malignant and benign ascites. Med Oncol. 2012;29:1397-402.

Foot NC. The identification of neoplastic cells in serous effusions; critical analysis of smears from 2,029 persons. Am J Pathol. 1956;32:961-77.

Sevinc A, Sari R, Fadillioglu E. The utility of lactate dehydrogenase isoenzyme pattern in the diagnostic evaluation of malignant and nonmalignant ascites. J Natl Med Assoc. 2005;97:79-84.

Colli A, Buccino G, Cocciolo M, Parravicini R, Mariani F, Scaltrini G. Diagnostic accuracy of sialic acid in the diagnosis of malignant ascites. Cancer. 1989;63:912-6.

Gerbes AL, Jungst D, Xie YN, Permanetter W, Paumgartner G. Ascitic fluid analysis for the differentiation of malignancy-related and nonmalignant ascites. Proposal of a diagnostic sequence. Cancer. 1991;68:1808-14.

Rana SV, Babu SG, Kocchar R. Usefulness of ascetic fluid cholesterol as a marker for malignant ascites. Med Sci Mon. 2005;11:136-42.

Sastry AS, Mahapatra SC, Dumpula V. Ascitic fluid analysis with special reference to serum ascites cholesterol gradient and serum ascites albumin gradient. Int J Res Med Sci. 2017;5:429-12.

Bijoor AR, Venkatesh T. Value of ascitic fluid cholesterol and serum-ascites albumin gradient in differentiating cirrhotic and malignancy related ascites. Indian J Clinic Biochem. 2001;16(1):106-9.

Vyakaranam S, Nori S, Sastry GM, Vyakaranam SB, Bhongir AV. Serum - Ascites Albumin and Cholesterol Gradients in Differential Diagnosis of Ascites. NJIRM. 2011;2(3):22-8.

Zhu H, Shen Y, Deng K. Diagnostic accuracy of ascitic cholesterol concentration for malignant ascites: a meta-analysis. International J Clinic Exp Med. 2015;8(10):18494-9.

Sood A, Garg R, Kumar R, Chhina RS, Arora S, Gupta R, et al. Ascitic fluid cholesterol in malignant and tubercular ascites. J Assoc Physicians India. 1995 Nov;43(11):745-7.