Skip to main content
NCBI home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 2003 May;79(931):292–294. doi: 10.1136/pmj.79.931.292

How valuable is ascitic cytology in the detection and management of malignancy?

R Karoo 1, T Lloyd 1, G Garcea 1, H Redway 1, G Robertson 1
PMCID: PMC1742707  PMID: 12782778

Abstract

Introduction: Ascitic cytology is often requested in the early stages of ascitic assessment. A review of this practice in a major English teaching hospital is presented.

Method: Patients were retrospectively identified using the histopathology and patient administration system between January 1999 and May 2001.

Results: Of 276 samples sent for assessment 35 cases were found to be negative when on further review an intra-abdominal malignancy was present. The malignancy was diagnosed using a radiological modality. The sensitivity of ascitic cytology was found to be 60% with 100% specificity. A delay of up to five days could be incurred awaiting the cytology results before further radiological examinations were undertaken.

Conclusion: Too much hope is placed on ascitic cytology to provide the diagnosis at the expense of other investigations. It is recommended that the initial assessment should concentrate on history, examination, and basic tests on ascitic fluid to assess the serum-ascites albumin gradient. Ovarian malignancy is the only tumour type yielding a significant rate of detection from cytology with some prognostic impact. Results should not be awaited before abdominal ultrasound is undertaken. This more directed practice would help reduce unnecessary workload for the pathologist and has resource implications.

Full Text

The Full Text of this article is available as a PDF (69.0 KB).

Selected References

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

  1. Blair S. L., Chu D. Z., Schwarz R. E. Outcome of palliative operations for malignant bowel obstruction in patients with peritoneal carcinomatosis from nongynecological cancer. Ann Surg Oncol. 2001 Sep;8(8):632–637. doi: 10.1007/s10434-001-0632-1. [DOI] [PubMed] [Google Scholar]
  2. 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]
  3. 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 Mar 1;63(5):912–916. doi: 10.1002/1097-0142(19890301)63:5<912::aid-cncr2820630521>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
  4. Enck Robert E. Malignant ascites. Am J Hosp Palliat Care. 2002 Jan-Feb;19(1):7–8. doi: 10.1177/104990910201900101. [DOI] [PubMed] [Google Scholar]
  5. Garrison R. N., Kaelin L. D., Galloway R. H., Heuser L. S. Malignant ascites. Clinical and experimental observations. Ann Surg. 1986 Jun;203(6):644–651. doi: 10.1097/00000658-198606000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Habeeb K. S., Herrera J. L. Management of ascites. Paracentesis as a guide. Postgrad Med. 1997 Jan;101(1):191-2, 195-200. doi: 10.3810/pgm.1997.01.149. [DOI] [PubMed] [Google Scholar]
  7. Konishi Masaru, Kinoshita Taira, Nakagohri Toshio, Inoue Kazuto, Oda Tatsuya, Takahashi Shinichiro. Prognostic value of cytologic examination of peritoneal washings in pancreatic cancer. Arch Surg. 2002 Apr;137(4):475–480. doi: 10.1001/archsurg.137.4.475. [DOI] [PubMed] [Google Scholar]
  8. Monte S. A., Ehya H., Lang W. R. Positive effusion cytology as the initial presentation of malignancy. Acta Cytol. 1987 Jul-Aug;31(4):448–452. [PubMed] [Google Scholar]
  9. Motherby H., Nadjari B., Friegel P., Kohaus J., Ramp U., Böcking A. Diagnostic accuracy of effusion cytology. Diagn Cytopathol. 1999 Jun;20(6):350–357. doi: 10.1002/(sici)1097-0339(199906)20:6<350::aid-dc5>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  10. Parsons S. L., Lang M. W., Steele R. J. Malignant ascites: a 2-year review from a teaching hospital. Eur J Surg Oncol. 1996 Jun;22(3):237–239. doi: 10.1016/s0748-7983(96)80009-6. [DOI] [PubMed] [Google Scholar]
  11. Parsons S. L., Watson S. A., Steele R. J. Malignant ascites. Br J Surg. 1996 Jan;83(1):6–14. doi: 10.1002/bjs.1800830104. [DOI] [PubMed] [Google Scholar]
  12. Ribeiro U., Jr, Gama-Rodrigues J. J., Safatle-Ribeiro A. V., Bitelman B., Ibrahim R. E., Ferreira M. B., Laudanna A. A., Pinotti H. W. Prognostic significance of intraperitoneal free cancer cells obtained by laparoscopic peritoneal lavage in patients with gastric cancer. J Gastrointest Surg. 1998 May-Jun;2(3):244–249. doi: 10.1016/s1091-255x(98)80019-x. [DOI] [PubMed] [Google Scholar]
  13. Ringenberg Q. S., Doll D. C., Loy T. S., Yarbro J. W. Malignant ascites of unknown origin. Cancer. 1989 Aug 1;64(3):753–755. doi: 10.1002/1097-0142(19890801)64:3<753::aid-cncr2820640330>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
  14. Runyon B. A., Hoefs J. C., Morgan T. R. Ascitic fluid analysis in malignancy-related ascites. Hepatology. 1988 Sep-Oct;8(5):1104–1109. doi: 10.1002/hep.1840080521. [DOI] [PubMed] [Google Scholar]
  15. 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]
  16. Shen-Gunther Jane, Mannel Robert S. Ascites as a predictor of ovarian malignancy. Gynecol Oncol. 2002 Oct;87(1):77–83. doi: 10.1006/gyno.2002.6800. [DOI] [PubMed] [Google Scholar]
  17. Simojoki M., Santala M., Vuopala S., Kauppila A. The prognostic value of peritoneal cytology in ovarian cancer. Eur J Gynaecol Oncol. 1999;20(5-6):357–360. [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES