Skip to main content
NCBI home page
Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 2001 Nov;54(11):831–835. doi: 10.1136/jcp.54.11.831

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

M Gulyas 1, A Kaposi 1, G Elek 1, L Szollar 1, A Hjerpe 1
PMCID: PMC1731306  PMID: 11684715

Abstract

Aim—To determine whether assays of carcinoembryonic antigen (CEA) and cholesterol in ascites add diagnostic value to cytology.

Methods—The additional diagnostic efficacy 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.

Key Words: ascitic fluid • carcinoembryonic antigen • cholesterol • cytology

Full Text

The Full Text of this article is available as a PDF (162.4 KB).

graphic file with name 00322.f1.jpg

Open in a new tab

Figure 1 Concentrations of carcinoembryonic antigen (CEA) and cholesterol in ascitic fluid. (A) All 130 cases and (B) 35 cases with inconclusive cytology. Benign effusion, open circles; carcinoma without peritoneal involvement, open triangles; peritoneal carcinomatosis, closed triangles. The cut off values for the two analyses are shown as broken lines.

graphic file with name 00322.f2.jpg

Open in a new tab

Figure 2 Performance of the carcinoembryonic antigen (CEA) analysis as a measure to detect peritoneal carcinomatosis: (A) receiver operating characteristic plot and (B) diagnostic efficacy as a function of cut off values for the total material and (C) for cases with inconclusive cytology. The last two curves are similar in shape, suggesting an optimal cut off of 5 ng/ml.

graphic file with name 00322.f3.jpg

Open in a new tab

Figure 3 Performance of the cholesterol analysis in detection of carcinomatosis: (A) receiver operating characteristic plot and (B) diagnostic efficacy as a function of cut off values for the total material and (C) for cases with inconclusive cytology. The optimal cut off value of 1.21 mmol/litre is the same for the two groups.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ammon A., Eiffert H., Reil S., Beyer J. H., Droese M., Hiddemann W. Tumor-associated antigens in effusions of malignant and benign origin. Clin Investig. 1993 Jun;71(6):437–444. doi: 10.1007/BF00180056. [DOI] [PubMed] [Google Scholar]
  2. Archimandritis A., Kapsalas D., Douvara M., Tjivras M., Tsirantonaki M., Fertakis A. Value of ascitic fibronectin and cholesterol concentration in the differentiation between malignancy-related and non-malignant ascites. Ann Med Interne (Paris) 1996;147(3):145–150. [PubMed] [Google Scholar]
  3. Cascinu S., Del Ferro E., Barbanti I., Ligi M., Fedeli A., Catalano G. Tumor markers in the diagnosis of malignant serous effusions. Am J Clin Oncol. 1997 Jun;20(3):247–250. doi: 10.1097/00000421-199706000-00007. [DOI] [PubMed] [Google Scholar]
  4. Caselmann W. H., Jüngst D. Isolation and characterization of a cellular protein-lipid complex from ascites fluid caused by various neoplasms. Cancer Res. 1986 Mar;46(3):1547–1552. [PubMed] [Google Scholar]
  5. Castaldo G., Oriani G., Cimino L., Topa M., Mostarda I., Castellano L., Del Vecchio-Blanco C., Budillon G., Salvatore F., Sacchetti L. Total discrimination of peritoneal malignant ascites from cirrhosis- and hepatocarcinoma-associated ascites by assays of ascitic cholesterol and lactate dehydrogenase. Clin Chem. 1994 Mar;40(3):478–483. [PubMed] [Google Scholar]
  6. Chen L. M., Lazcano O., Katzmann J. A., Kimlinger T. K., Li C. Y. The role of conventional cytology, immunocytochemistry, and flow cytometric DNA ploidy in the evaluation of body cavity fluids: a prospective study of 52 patients. Am J Clin Pathol. 1998 Jun;109(6):712–721. doi: 10.1093/ajcp/109.6.712. [DOI] [PubMed] [Google Scholar]
  7. Gerbes A. L., Hoermann R., Mann K., Jüngst D. Human chorionic gonadotropin-beta in the differentiation of malignancy-related and nonmalignant ascites. Digestion. 1996;57(2):113–117. doi: 10.1159/000201324. [DOI] [PubMed] [Google Scholar]
  8. Gerbes A. L., Jüngst D., Xie Y. N., Permanetter W., Paumgartner G. Ascitic fluid analysis for the differentiation of malignancy-related and nonmalignant ascites. Proposal of a diagnostic sequence. Cancer. 1991 Oct 15;68(8):1808–1814. doi: 10.1002/1097-0142(19911015)68:8<1808::aid-cncr2820680827>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  9. Gerbes A. L., Xie Y. N., Mezger J., Jüngst D. Ascitic fluid concentrations of fibronectin and cholesterol: comparison of differential diagnostic value with the conventional protein determination. Liver. 1990 Jun;10(3):152–157. doi: 10.1111/j.1600-0676.1990.tb00451.x. [DOI] [PubMed] [Google Scholar]
  10. Gupta R., Misra S. P., Dwivedi M., Misra V., Kumar S., Gupta S. C. Diagnosing ascites: value of ascitic fluid total protein, albumin, cholesterol, their ratios, serum-ascites albumin and cholesterol gradient. J Gastroenterol Hepatol. 1995 May-Jun;10(3):295–299. doi: 10.1111/j.1440-1746.1995.tb01096.x. [DOI] [PubMed] [Google Scholar]
  11. Joseph M. G., Banerjee D., Harris P., Gibson S., McFadden R. G. Multiparameter flow cytometric DNA analysis of effusions: a prospective study of 36 cases compared with routine cytology and immunohistochemistry. Mod Pathol. 1995 Aug;8(6):686–693. [PubMed] [Google Scholar]
  12. Lee J. S., Nam J. H., Lee M. C., Park C. S., Juhng S. W. Immunohistochemical panel for distinguishing between carcinoma and reactive mesothelial cells in serious effusions. Acta Cytol. 1996 Jul-Aug;40(4):631–636. doi: 10.1159/000333930. [DOI] [PubMed] [Google Scholar]
  13. Mezger J., Permanetter W., Gerbes A. L., Wilmanns W., Lamerz R. Tumour associated antigens in diagnosis of serous effusions. J Clin Pathol. 1988 Jun;41(6):633–643. doi: 10.1136/jcp.41.6.633. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Mortensen P. B., Kristensen S. D., Bloch A., Jacobsen B. A., Rasmussen S. N. Diagnostic value of ascitic fluid cholesterol levels in the prediction of malignancy. Scand J Gastroenterol. 1988 Nov;23(9):1085–1088. doi: 10.3109/00365528809090173. [DOI] [PubMed] [Google Scholar]
  15. Pinto M. M. CA-15.3 assay in effusions: comparison with carcinoembryonic antigen and CA-125 assay and cytologic diagnosis. Acta Cytol. 1996 May-Jun;40(3):437–442. doi: 10.1159/000333895. [DOI] [PubMed] [Google Scholar]
  16. Pinto M. M. DNA analysis of malignant effusions. Comparison with cytologic diagnosis and carcinoembryonic antigen content. Anal Quant Cytol Histol. 1992 Jun;14(3):222–226. [PubMed] [Google Scholar]
  17. Runyon B. A. Care of patients with ascites. N Engl J Med. 1994 Feb 3;330(5):337–342. doi: 10.1056/NEJM199402033300508. [DOI] [PubMed] [Google Scholar]
  18. Runyon B. A. Malignancy-related ascites and ascitic fluid "humoral tests of malignancy". J Clin Gastroenterol. 1994 Mar;18(2):94–98. doi: 10.1097/00004836-199403000-00002. [DOI] [PubMed] [Google Scholar]
  19. Spehn J., Iwanetz S., Schmitz-Huebner U. Immuzytochemische Untersuchung von Pleuraerguss und Aszites mit Ber-EP-4-Antikörpern. Dtsch Med Wochenschr. 1995 Sep 8;120(36):1197–1200. doi: 10.1055/s-2008-1055465. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Publishing Group

RESOURCES