Determination of the optimal volume of ascitic fluid for the precise diagnosis of malignant ascites

Zhang, Feifei; Feng, Zhenning; Zhang, Yichi; Liu, Zishuai; Sun, Xiaoli; Jin, Shizhu

doi:10.4103/sjg.sjg_547_18

Cited by 13 publications

(3 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Zhang et al, in their study of 123 ascitic fluid patients, reported a cutoff value of 200 mL [31], while Rooper et al, with a cohort of 2665 patients with ascites, proposed a volume of 80 mL [32]. For pericardial effusions, Rooper et al have considered 60 mL as optimal [33], while Dragoescu et al, with a cohort of 128 pericardial effusion patients, with a mean volume of 60 mL and a malignancy rate of 24.2%, did not find an optimal volume [34].…”

Section: Discussionmentioning

confidence: 99%

Optimal Volume Assessment for Serous Fluid Cytology

Christofidis,

Theochari,

Mavropoulos Papoudas

et al. 2024

Biomedicines

View full text Add to dashboard Cite

Objective: This study aimed to investigate the optimal volume of serous fluid needed for accurate diagnosis using The International System for Reporting Serous Fluid Cytopathology (TIS), as well as to provide information on the distribution of serous effusion cases in the TIS categories (ND: non-diagnostic, NFM: negative for malignancy, AUS: atypia of undetermined significance, SFM: suspicious for malignancy, MAL: malignant) and relevant epidemiological data. Methods: A retrospective analysis of 2340 serous effusion cases (pleural, peritoneal, and pericardial) from two hospitals between 2018 and 2020 was conducted. TIS categories were assigned to each case, and for 1181 cases, these were correlated with the volume of the analyzed fluid. Results: Our study found statistically significant differences in volume distributions between certain TIS categories. Statistically lower volumes were observed in NFM compared to MAL, in UNCERTAIN (ND, AUS, SFM) compared to both MAL and NFM, and in NOT MAL (ND, NFM, AUS, SFM) compared to MAL. However, these differences were not substantial enough to hold any clinical relevance. Conclusions: This study suggests that while fluid volume may slightly influence the TIS category, it does not impact the diagnostic accuracy of serous effusion cytology. Therefore, the ideal serous effusion specimen volume can be defined solely by practical parameters.

show abstract

Section: Discussionmentioning

confidence: 99%

Optimal Volume Assessment for Serous Fluid Cytology

Christofidis,

Theochari,

Mavropoulos Papoudas

et al. 2024

Biomedicines

View full text Add to dashboard Cite

show abstract

“…No clear‐cut guidelines exist in the current system recommending the minimum volume of sample required for labelling it as NFM. A study conducted by Zhang et al for the determination of the optimal volume of ascitic fluid in the precise diagnosis of malignant ascites concluded that the sensitivity for the diagnosis of malignant ascites is closely related to the volume of peritoneal fluid that is extracted by peritoneocentesis 27 …”

Section: Discussionmentioning

confidence: 99%

Categorisation of peritoneal serous effusions using the International System for Reporting Serous Fluid Cytopathology—A study on gynaecological samples

et al. 2023

View full text Add to dashboard Cite

Background Cytology of serous effusions is an indispensable diagnostic tool for the diagnosis of non‐neoplastic as well as neoplastic effusions, aiding in the categorisation, staging, and prognostication of the patient. This study focuses on reclassifying cases of peritoneal fluid cytology following the International System for Reporting Serous Fluid Cytopathology (TIS), highlighting various challenges encountered and adding to the body of data regarding the risk of malignancy (ROM), focussing on peritoneal effusions due to gynaecological causes. Methods Peritoneal effusion samples were retrieved from our department's archives and reclassified according to the TIS. The ROM for each category was calculated based on available surgical follow‐up. Results A total of 818 peritoneal effusions were studied. Following the definitions and guidelines of the TIS, the cases were reclassified with 125 (15.2%) in the category of non‐diagnostic (ND), 595 (72.7%) as negative for malignancy (NFM), 26 (3.2%) as atypia of undetermined significance (AUS), 12 (1.5%) as suspicious for malignancy (SFM), and 60 (7.3%) as malignant (MAL). The respective ROM values for each category were 16.9%, 12.1%, 50%, 80%, and 100%, respectively. By considering the MAL and SFM groups as positive, and the ND, NFM, and AUS groups as negative, the diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were determined as 85.2%, 36.7%, 99.1%, 91.7%, and 84.5%, respectively. Conclusions Peritoneal cytology categorisation following the proposed TIS offered a practical approach for categorisation of the fluids received. The ROMs reported in our study were mostly concordant with those published according to the TIS.

show abstract

“…It is of clinical interest in determining the standards for adequate sampling. Previous correlational studies have proposed cutoffs of 80-200 mL for volume adequacy [1][2][3]. This recommendation may not be always practical where patient and disease factors limit fluid volume and may not apply to specimens collected or divided in consecutive aliquots.…”

Section: Introductionmentioning

confidence: 99%

Number Needed to Diagnose in Malignant Ascites: Effects of Volume, Repeating Collection, and Primary Malignancy on Diagnostic Performance in Peritoneal Fluid Cytology

Chow

Ngai

et al. 2023

Acta Cytologica

View full text Add to dashboard Cite

Introduction Volume recommendations of 80-200ml have been proposed for peritoneal fluid cytology. While cut-offs are impractical when volume is limited by the amount present and disease factors, collections, however, can be repeated. This study addresses adequacy and number needed to diagnose by comparing diagnostic agreement to volumes in single specimens, total volumes collected daily, and within admissions. The diagnostic yield of repeating collection within a single day, admission, and throughout admissions of a patient’s lifetime was also investigated. Methods Peritoneal fluid cytology specimens over a 27-year period were retrieved, and matched by collection date, admission number and patient number. Case notes were reviewed to establish all cases of malignant ascites. Results In total, 19,392 specimens from 14,327 admissions and 11,089 patients were retrieved, with 1,531 patients confirmed with malignant ascites. Agreements between cytologic diagnoses within the same day and admission were high (κ>0.8). Fluid volume increased with grade of cytologic diagnosis (p<0.001), and greater volume was associated with higher discordance (p<0.05). Specimens of 60-100ml showed the best diagnostic concordance. To achieve a 99.5% diagnostic rate, three sequential aliquots, collections from two different days in an admission, or three admissions within a lifetime is required. The diagnostic yield of one aliquot within batches from the same day was only 88.9%. Gastrointestinal (p=0.040), gynecologic (p=0.005) and lung (p<0.001) malignancies required the least repeats for diagnosis. Conclusions Omission of any fluid from laboratory submission is strongly discouraged. As a simple rule, three repeats are necessary for excluding malignant ascites.

show abstract

Determination of the optimal volume of ascitic fluid for the precise diagnosis of malignant ascites

Cited by 13 publications

References 22 publications

Optimal Volume Assessment for Serous Fluid Cytology

Optimal Volume Assessment for Serous Fluid Cytology

Categorisation of peritoneal serous effusions using the International System for Reporting Serous Fluid Cytopathology—A study on gynaecological samples

Number Needed to Diagnose in Malignant Ascites: Effects of Volume, Repeating Collection, and Primary Malignancy on Diagnostic Performance in Peritoneal Fluid Cytology

Contact Info

Product

Resources

About