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

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.

Peptide Receptor Radionuclide Therapy–Induced Hepatotoxicity in Patients With Metastatic Neuroendocrine Tumors

“…There is no published literature documenting the specific sensitivity of peritoneal fluid analysis for malignant ascites in metastatic NET, but there is a published 60% sensitivity for ascitic cytology with any intra-abdominal malignancy. 25 The putative etiology for the development of ascites after PRRT is possibly a presinusoidal portal hypertension with exacerbation by radionuclide toxicity. Studies have shown hepatocellular apoptosis and peribiliary fibrosis after chemoembolization.…”

EUS-guided FNA of peritoneal carcinomatosis in patients with unknown primary malignancy

“…In general, the sensitivity of ascitic cytology is approximately 60%, with a specificity of 100%. 2 Two thirds of patients with malignant-related ascites have PC, and 96.7% of patients with PC have positive ascitic fluid cytology. 3 Direct visualization by laparoscopy, although minimally invasive, has its limitations, such as tumor seeding and associated morbidity.…”

Study of Peritoneal Fluid- An Experience in a Tertiary Care Rural Hospital

“…This study is in agreement with Udasimath et al study 7 . Studies by Hwangbo et al, Khan et al and Mahmood et al 8,9,10 in their studies reported liver cirrhosis to be the most common etiology amongst non-malignant causes of ascites. As seen in their studies, liver was the most common setting for ascites as in our study.…”