2014, Number 3
<< Back Next >>
Ann Hepatol 2014; 13 (3)
Evaluation of tumor markers for the differential diagnosis of benign and malignant ascites
Liu F, Kong X, Dou Q, Ye J, Xu D, Shang H, Xu K, Song Y
Language: English
References: 25
Page: 357-363
PDF size: 86.88 Kb.
ABSTRACT
Introduction. The diagnosis of malignant ascites is a challenging problem in clinical practice, non-invasive
techniques should be developed to improve diagnostic accuracy. The diagnostic performances of tumor
markers in malignant ascites remained unsettled. Our aim was to evaluate diagnostic performance of
tumor markers in differential diagnosis of benign and malignant ascites.
Material and methods. A total
of 437 patients were enrolled, and the relevant parameters of the patients were analyzed for the differentiation of benign ascites from malignant ascites.
Results. At the predetermined cutoff values of tumor makers, tumor markers in ascitic fluid showed better diagnostic performance than those in serum. Combined use of tumor markers and the cytology increased the diagnostic yield of the latter by 37%. In cytologically negative malignant ascites, tumor markers provided assistance in differentiating malignant ascites from benign ascites, and the combination of ascitic tumor markers yielded 86% sensitivity, 97% specificity.
Conclusion. Use of a panel of tumor markers exhibited excellent diagnostic performance in diagnosing
malignant ascites, which indicated the detection of tumor markers may represent a beneficial adjunct
to cytology, thus guiding the selection of patients who might benefit from further invasive procedures.
REFERENCES
Runyon BA. Management of adult patients with ascites due to cirrhosis. Hepatology 2004; 39: 841-56.
Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49: 2087-107.
Becker G, Galandi D, Blum HE. Malignant ascites: systematic review and guideline for treatment. Eur J Cancer 2006; 42: 589-97.
Sangisetty SL, Miner TJ. Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measures. World J Gastrointest Surg 2012; 4: 87-95.
Pinto MM. CA-15.3 assay in effusions: comparison with carcinoembryonic antigen and CA-125 assay and cytologic diagnosis. Acta Cytol 1996; 40: 437-42.
Cascinu S, Del Ferro E, Barbanti I, Ligi M, Fedeli A, Catalano G. Tumor markers in the diagnosis of malignant serous effusions. Am J Clin Oncol 1997; 20: 247-50.
Ammon A, Eiffert H, Reil S, Beyer JH, Droese M, Hiddemann W. Tumor-associated antigens in effusions of malignant and benign origin. Clin Investig 1993; 71: 437-44.
Jenkins PF, Ward MJ. The role of peritoneal biopsy in the diagnosis of ascites. Postgrad Med J 1980; 56: 702-3.
Luck NH, Khan AA, Alam A, Butt AK, Shafquat F. Role of laparoscopy in the diagnosis of low serum ascites albumin gradient. J Pak Med Assoc 2007; 57: 33-4.
Chen SJ, Wang SS, Lu CW, Chao Y, Lee FY, Lee SD, Wu SL, et al. Clinical value of tumour markers and serum-ascites albumin gradient in the diagnosis of malignancy-related ascites. J Gastroenterol Hepatol 1994; 9: 396-400.
Loewenstein MS, Rittgers RA, Feinerman AE, Kupchik HZ, Marcel BR, Koff RS, Zamcheck N. Carcinoembryonic antigen assay of ascites and detection of malignancy. Ann Intern Med 1978; 88: 635-8.
Passebosc-Faure K, Li G, Lambert C, Cottier M, Gentil-Perret A, Fournel P, Perol M, et al. Evaluation of a panel of molecular markers for the diagnosis of malignant serous effusions. Clin Cancer Res 2005; 11: 6862-7.
Porcel JM, Vives M, Esquerda A, Salud A, Perez B, Rodriguez- Panadero F. Use of a panel of tumor markers (carcinoembryonic antigen, cancer antigen 125, carbohydrate antigen 15-3, and cytokeratin 19 fragments) in pleural fluid for the differential diagnosis of benign and malignant effusions. Chest 2004; 126: 1757-63.
Shahab N. Tumor markers in malignant ascites. Arch Intern Med 2002; 162: 949-50.
Singer G, Rebmann V, Chen YC, Liu HT, Ali SZ, Reinsberg J, McMaster MT, et al. HLA-G is a potential tumor marker in malignant ascites. Clin Cancer Res 2003; 9: 4460-4.
Tuzun Y, Celik Y, Bayan K, Yilmaz S, Dursun M, Canoruc F. Correlation of tumour markers in ascitic fluid and serum: are measurements of ascitic tumour markers a futile attempt? J Int Med Res 2009; 37: 79-86.
Tuzun Y, Yilmaz S, Dursun M, Canoruc F, Celik Y, Cil T, Boyraz T. How to increase the diagnostic value of malignancy- related ascites: discriminative ability of the ascitic tumour markers. J Int Med Res 2009; 37: 87-95.
Wang T, Qian X, Wang Z, Wang L, Yu L, Ding Y, Liu B. Detection of cell-free BIRC5 mRNA in effusions and its potential diagnostic value for differentiating malignant and benign effusions. Int J Cancer 2009; 125: 1921-5.
Runyon BA, Hoefs JC, Morgan TR. Ascitic fluid analysis in malignancy-related ascites. Hepatology 1988; 8: 1104-9.
Wu SS, Lin OS, Chen YY, Hwang KL, Soon MS, Keeffe EB. Ascitic fluid carcinoembryonic antigen and alkaline phosphatase levels for the differentiation of primary from secondary bacterial peritonitis with intestinal perforation. J Hepatol 2001; 34: 215-21.
Bedrossian CW. Diagnostic problems in serous effusions. Diagn Cytopathol 1998; 19: 131-7.
Nguyen HN. Extreme CA125 elevation from hepatitis C and ascites. Gynecol Oncol 1998; 70: 441-2.
Runyon BA. Malignancy-related ascites and ascitic fluid “humoral tests of malignancy”. J Clin Gastroenterol 1994; 18: 94-8.
Sevinc A, Sari R, Buyukberber S. Cancer antigen 125: tumor or serosal marker in case of ascites? Arch Intern Med 2001; 161: 2507-8.
Zuckerman E, Lanir A, Sabo E, Rosenvald-Zuckerman T, Matter I, Yeshurun D, Eldar S. Cancer antigen 125: a sensitive marker of ascites in patients with liver cirrhosis. Am J Gastroenterol 1999; 94: 1613-8.