Diagnostic Value of Ascitic Fluid Cholesterol Levels in the Prediction of Malignancy

Abstract

In a prospective study abdominal paracentesis with ascitic fluid aspiration was performed in 54 consecutive patients with ascites of unknown cause. The ascitic fluid was examined cytologically and bacteriologically. The total cholesterol concentration was measured with an enzymatic colorimetric method. Malignant disease was diagnosed in 34 patients. Two of them had both malignant disease and liver cirrhosis and were excluded. Seventeen patients had liver cirrhosis, one had acute pancreatitis, and two had decompensated heart disease. The diagnostic value of an ascitic cholesterol concentration greater than 1.2 mmol/l in terms of predicting malignant disease was 87.5% (95% confidence limits, 71.0-96.5). The predictive value of an ascitic cholesterol concentration less than or equal to 1.2 mmol/l in terms of benign disease was 80.0% (95% confidence limits, 56.3-94.3). It is concluded that ascitic cholesterol measurement is a valuable supplement to cytologic examination in distinguishing between ascites of malignant and benign origin.

Value of combined detection of AFU and TCH in differential diagnosis between malignant and non-tuberculous benign ascites

“…TCH may originate in cell membranes, perhaps as a result of disintegration of tumor cells and/or surrounding benign cells [8,13]. It can also enter the cavity from the interstitial space because of obstructed lymph vessels or be related to increased permeability of the carcinomatous serous membrane [16,33]. Raised cholesterol concentrations have also been reported in inflammatory conditions involving the peritoneum and associated with chronic cardiac congestion [16,34].…”

“…Therefore, complete separation between malignant ascites and nonmalignant ascites has not been always possible. To increase diagnostic efficiency, cytologic evaluation has been coupled with the analysis in both serum and ascitic fluid for total protein [10,11], various enzymes [9], fibronectin [11,12], tumor antigens [13,14], and lipids [15][16][17], etc.…”

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

“…The most reliable way to exclude involvement of the peritoneum by a tumour is to perform a thorough postmortem examination, and results that are not corrected for inadequate follow up are diYcult to interpret. 13 In our study, we investigated the possible additional value of cholesterol and CEA assays to ascites cytology-in particular, when the cytological findings alone are inconclusive. In all cases, the results of cytological and chemical analyses were related to the stratified true diagnosis-that is, the presence or absence of peritoneal malignancy, as established at necropsy and/or histological examination.…”

Pathophysiology of elevated ascites fluid cholesterol in malignant ascites

“…In an additional study, markedly elevated concentrations of total cholesterol were found in malignant and inflammatory ascitic fluid compared to ascites from patients with cirrhosis (2). Recently these findings have been confirmed and the clinical value of ascitic cholesterol to differentiate between cirrhotic and malignant ascites has been established (3)(4)(5)(6)(7). The pathogenesis of high ascitic cholesterol levels in patients with malignant disease is not fully understood.…”

“…It has been demonstrated that ascites cholesterol concentrations are markedly elevated in peritoneal carcinomatosis compared to cirrhosis and ascites cholesterol has been established as a parameter useful for the differential diagnosis of ascites (3)(4)(5)(6)(7). In an attempt to explain the elevated cholesterol concentration in malignant ascites, we compared the ascites to serum relation of proteins and lipoproteins in patients with cirrhosis or peritoneal carcinomatosis.…”