OJGas  Vol.2 No.3 , August 2012
Diagnostic value of a panel of tumor markers as a part of a diagnostic work-up for ascites of unknown etiology
ABSTRACT
Background & objectives: Data regarding tumor marker usefulness in diagnosing ascites of unknown etiology and determining its malignant nature are conflicting. We aim to assess the diagnostic value of ascitic and serum tumor markers in ascites of unknown etiology and to evaluate their usefulness besides other laboratory tests in a diagnostic work-up in those patients. Design & setting: A prospective case-control study conducted at Assiut University hospital and oncology institute. Patients & Methods: Three groups were included; Group I: 41 patients with ascites of unknown etiology Group II: 7 Patients with TB ascites and Group III:14 patients with cirrhotic ascites. We assessed the CEA, CEA mRNA, CA15-3, CA19.9, CA125, AFP and PSA in serum and ascetic fluid. A diagnostic work-up for group I included: IPD test, ultrasound, CT, ascetic fluid cytology, SAAG, Laparotomy and biopsy. Results: Ascetic fluid and serum levels of CA15-3 and CA125 were significantly increased in group I and were significantly increased in histopathologically proved malignant ascites compared to TB and cirrhotic ascites. In group I, CA 125 was significantly higher in ascites than serum. With the exception of PSA, all tumor markers significantly correlated in serum and ascetic fluid. No significant difference in the level of ascetic CEA messenger RNA was detected between the 3 groups. Cytology had 53% sensitivity, 94% specificity and CA 125 & CA15-3 had 81% sensitivity and 75% specificity in detection of malignant ascites repectively. Laparotomy and biopsy: diagnosed malignnancy in 53.3% and TB in 13.3%. Conclusions: A diagnostic work-up including SAAG, tumor markers in the serum and ascetic fluid may help in adjunct with ascetic fluid cytology, laparotomy and biopsy, imag- ing and other laboratory tests in diagnosing ascites of unknown etiology.

Cite this paper
Abdelmoniem, S. , Zaki, E. , Imam, H. , Badrawy, H. , Ali, S. and Maximous, D. (2012) Diagnostic value of a panel of tumor markers as a part of a diagnostic work-up for ascites of unknown etiology. Open Journal of Gastroenterology, 2, 93-100. doi: 10.4236/ojgas.2012.23020.
References
[1]   Han, C.M., Lee, C.L., Huang, K.G., Chu, C.M., Lin, S.M., Wang, C.J., et al. (2008) Diagnostic laparoscopy in ascites of unknown origin: Chang Gung Memorial Hospi- tal 20-year experience. Chang Gung Medical Journal, 31, 378-383.

[2]   Alexandrakis, M., Moschandrea, J., Koulocheri, S., Kour- oumalis, E. and Eliopoulos, G. (2000) Discrimination between malignant and nonmalignant ascites using serum and Ascitic fluid proteins in a multivariate analysis model. Digestive Diseases and Sciences, 45, 500-508. doi:10.1023/A:1005437005811

[3]   Chen, S.J., Wang, S.S., Lu, C.W., Chao, Y., Lee, F.Y., Lee, S.D., et al. (1994) Clinical value of tumour markers and serum-ascites albumin gradient in the diagnosis of malignancy-related ascites. Journal of Gas-troenterology and Hepatology, 9, 396-400. doi:10.1111/j.1440-1746.1994.tb01262.x

[4]   Sari, R., Yildirim, B., Sevinc, A., Bahceci, F. and Hilmio- glu, F. (2001) The importance of serum and ascites fluid alpha-fetoprotein, carcinoembryonic antigen, CA 19-9, and CA 15-3 levels in differential diagnosis of ascites etiology. Hepato-Gastroenterology, 48, 1616-1621

[5]   Engelhardt, R., Fetscher, S. and Otto, F. (2008) Tumor markers. In: Berger, D.P., Engelhardt, M., Hen?, H. and Mertelsmann, R., Eds., Concise Manual of Hematology and Oncology, Springer, Berlin, Heidelberg, New York, pp. 811-816.

[6]   Pissaia, A., Jr., Bernard, D., Scatton, O., Soubrane, O., Conti, F. and Calmus, Y. (2009) Significance of serum tumor markers carcinoembryonic antigen, CA 19-9, CA 125, and CA 15-3 in pre-orthotopic liver transplantation evaluation. Transplantation Proceedings, 41, 682-684. doi:10.1016/j.transproceed.2008.12.015

[7]   Simsek, H., Savas, M.C., Kadayifci, A. and Tatar, G. (1997) Elevated serum CA 125 concentration in patients with tuberculous peritonitis: A case-control study. The American Journal of Gastroenterology, 92, 1174-1176.

[8]   Tuzun, Y., Celik, Y., Bayan, K., Yilmaz, S., Dursun, M. and Canoruc, F. (2009) Correlation of tumour markers in ascitic fluid and serum: Are measurements of ascetic tu- mour markers a futile attempt? The Journal of Interna- tional Medical Research, 37, 79-86.

[9]   Jung, M., Jeung, H.C., Lee, S.S., Park, J.Y., Hong, S., Lee, S.H., et al. (2010) The clinical significance of ascitic fluid CEA in advanced gastric cancer with ascites. Journal of Cancer Research and Clinical Oncology, 36, 517-526. doi:10.1007/s00432-009-0684-3

[10]   Miura, M., Ichikawa, Y., Tanaka, K., Kamiyama, M., Hamaguchi, Y., Ishikawa, T., et al. (2003) Real-time PCR (TaqMan PCR) quantification of carcinoembryonic antigen (CEA) mRNA in the peripheral blood of colo- rectal cancer patients. Anticancer Research, 23, 1271- 1276.

[11]   Das, B.B., Purohit, A., Acharya, U. and Treskova, E. (2001) Serum-ascites albumin gradient: A predictor of esophageal varices with ascites. Indian Journal of Pedi- atrics, 68, 511-514. doi:10.1007/BF02723242

[12]   Khan, J., Pikkarainen, P., Karvonen, A.L., M?kel?, T., Per?aho, M., Pehkonen, E., et al. (2009) Ascites: Aetiol- ogy, mortality and the prevalence of spontaneous bacte- rial peritonitis. Scandinavian Journal of Gastroenterology, 44, 970-974. doi:10.1080/00365520902964739

[13]   Tuzun, Y., Yilmaz, S., Dursun, M., Canoruc, F., Celik, Y., Cil, T., et al. (2009) How to increase the diagnostic value of malignancy-related ascites: Discriminative ability of the ascetic tumor markers. The Journal of International Medical Research, 37, 87-95.

[14]   Motherby, H., Nadjari, B. and Friegel, P. (1999) Diag- nostic accuracy of effusion cytology. Diagnostic Cytopa- thology, 20, 350-357. doi:10.1002/(SICI)1097-0339(199906)20:6<350::AID-DC5>3.0.CO;2-7

[15]   Castaldo, G., Oriani, G., Cimino, L., Topa, M., Mostarda, I., Castellano, L., et al. (1994) Total discrimination of peritoneal malignant ascites from cirrhosis- and hepato- carcinoma-associated ascites by assays of ascetic choles- terol and lactate dehydrogenase. Clinical Chemistry, 40, 478-483.

[16]   Thrall, M.J. and Giampoli, E.J. (2009) Routine review of ascites fluid from patients with cirrhosis or hepato-cellular carcinoma is a low-yield procedure: An observational study. CytoJournal, 6, 16. doi:10.4103/1742-6413.54919

[17]   Callen, P.W., Marks, W.M. and Filly, R.A. (1979) Com- puted tomography and ultraso-nography in the evaluation of the retroperitoneum in patients with malignant ascites. Journal of Computer Assisted Tomog-raphy, 3, 581-584. doi:10.1097/00004728-197910000-00001

[18]   Yoon, Y.J., Ahn, S.H., Park, J.Y., Chon, C.Y., Kim, D.Y., Park, Y.N. and Han, K.H. (2007) What is the role of diag- nostic laparoscopy in a gastroenterology unit? Journal of Gastroenterology, 42, 881-886. doi:10.1007/s00535-007-2106-0

[19]   Saif, M.W., Siddiqui, I.A. and Sohail, M.A. (2009) Man- agement of ascites due to gastrointestinal malignancy. Annals of Saudi Medicine, 29, 369-377. doi:10.4103/0256-4947.55167

[20]   Gulati, M.S., Sarma, D. and Paul, S.B. (1999) CT ap- pearances in abdominal tubercu-losis. A pictorial essay. Clinical Imaging, 23, 51-59. doi:10.1016/S0899-7071(98)00090-4

[21]   Piura, B., Rabinovich, A., Leron, E., Yanai-Inbar, I. and Mazor, M. (2003) Peritoneal tuberculosis--an uncommon disease that may deceive the gynecologist. European Journal of Obstetrics & Gynecology and Reproductive Biology, 110, 230-234. doi:10.1016/S0301-2115(03)00101-5

[22]   Han, C.-M., Lee, C.-L., Huang, K.-G., Chu, C.-M., Lin, S.-M., Wang, C.-J., et al. (2008) Diagnostic laparoscopy in ascites of unknown origin: Chang Gung Memorial Hospital 20-year experience. Chang Gung Medical Jour- nal, 31, 310-313.

 
 
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