ABSTRACT
Aim: The study aimed to determine the diagnostic values for lactate dehydrogenase (LDH) and serum ascites albumin gradient (SAAG) with maximum sensitivity and minimum false positivity so as to differentiate malignancy-related ascites from non-malignant ascites in South West region of Nigeria. Study Design: This is a cross sectional study to determine the correlation between ascitic fluid LDH and SAAG and malignant and non-malignant ascites. Place and Duration of Study: This study was carried out at the clinics of gastroenterology, surgery, and obstetrics/gynecology at the Lagos University Teaching Hospital (LUTH), between August 2011 and July 2013. Methods: A total of 75 patients with ascites admitted into Lagos University Teaching Hospital (LUTH) from 2011 to 2013 were enrolled for the study. Thirty seven (7males, 30 females) had malignancy-related ascites while 38(18 males, 20 females) had non-malignant ascites. Levels of LDH and SAAG were determined in all patients with ascites. Statistical analysis was performed using SPSS software application (version 15.0) and p˂0.05 was considered statistically significant and results expressed as mean ± standard deviation. Results: A total of 75 patients were recruited for the study. Twenty-five of them (33.3%) were males while 50(66.7%) were females. The mean age for both sexes was 59.03±13.54 years. Using Receiver Operator Characteristic (ROC) curve, cut-off levels were 11.5 for SAAG and 310 IU/l for LDH. These cut-offs divided the malignant from the non-malignant group. Higher levels of ascitic LDH were seen in the malignant group (900.67±918.45 IU/l) when compared to the non-malignant group (199.29±194.53 IU/l). This was statistically significant (P<0.05). The diagnostic accuracy of LDH was 90.7%. SAAG was lower in the malignant (6.74±4.84 g/L) group when compared to the non-malignant (13.56±7.50 g/L). This was also statistically significant (P<0.05). The diagnostic accuracy of SAAG was 73.3%. Conclusion: It was concluded that measurement of ascitic fluid LDH and SAAG were relevant in differentiating malignant from non-malignant ascites. The determined cut-off values for LDH and SAAG in this study provides the distinctive differential diagnosis between malignant and nonmalignant ascites. Routine analysis of serum and ascitic fluid albumin and LDH will resolve the problem of malignant and non-malignant ascites especially in low-resource areas or in the developing world.
ABSTRACT
Background and Aims: So far, the differentiation between malignant and non-malignant ascites by laboratory parameters has not been fully achieved yet. Fibronectin is a glycoprotein which plays an important role in cell adhesion, growth, migration, and differentiation. The aim of the study was to assess the accuracy of fibronectin for the diagnosis of malignant ascites and to compare it with conventional use of cytology. Study Design: A cross sectional study to determine the correlation between ascitic fluid fibronectin and malignant and non-malignant ascites. Place and Duration of Study: This study was carried out at the clinics of gastroenterology, surgery, and obstetrics/gynecology at the Lagos University Teaching Hospital (LUTH), between August 2011 and July 2013. Methods: Ascitic fluid and serum samples from 75 patients were taken. 37 of them (7 males and 30 females) had malignancy-related ascites (Group 1), while the other 38 (18 males and 20 females) had non-malignant ascites (Group 2) respectively. These were analysed for fibronectin, lactate dehydrogenase (LDH), total protein, and albumin. Cytology was also done for all ascitic fluid samples. Results: Mean values of ascitic fluid fibronectin and LDH were higher in malignancy-related ascites (97.5 μg/ml, and 900.60 IU/L) respectively than in non-malignant ascites (47.7 μg/ml, and 199.31 IU/L) respectively (P less than 0.001). Ascitic fluid fibronectin with a cut-off value of 73 μg/ml gave the best diagnostic accuracy with a sensitivity and specificity of 94.7% and 94.6% respectively, while ascitic fluid LDH with a cut-off value of 310 IU/L gave diagnostic accuracy with a sensitivity and specificity of 97.3% and 84.2% respectively. The mean total protein level in the malignant group was 38.72±18.00 g/L and 30.21±15.00 g/L for the non-malignant group. The mean albumin levels were 28.08±10.32 g/L and 31.23±10.01 g/L for the malignant and non-malignant groups respectively. For both total protein and albumin, the P value was statistically insignificant. In this study, cytology yielded a sensitivity of 56.8% and a specificity of 100%. Conclusion: The results of this study suggest that fibronectin concentration in ascitic fluid may be useful in differentiating malignant from non-malignant ascites and could supplement cytology in the differential diagnosis of ascites. Further studies are needed to confirm these results.
ABSTRACT
Aim: This study was done to assess and evaluate the diagnostic accuracy of cholesterol and protein in differentiating ascites into malignant and non-malignant group in comparison with cytology. Study Design: A cross sectional study to determine the correlation between ascitic fluid cholesterol and protein and malignant and non-malignant ascites. Place and Duration of Study: This study was carried out at the clinics of gastroenterology surgery, and obstetrics/gynecology at the Lagos University Teaching Hospital (LUTH), between August 2011 and July 2013. Methodology: A total of 75 consecutive patients of Nigerian origin with ascites (37 malignant and 38 non-malignant) were studied for total cholesterol and total protein concentration in ascites. Also, cytology was done for all the 75 samples of ascitic fluid. Statistical analyses were carried out using SPSS software (version 15.0), and the level of significance set at p<0.05 and p<0.001. Results: The ascitic fluid cholesterol and protein levels in malignant ascites were higher (values of 103.10±30.00 mg/dL for cholesterol and 38.72±18.00 g/L for protein respectively) than in nonmalignant ascites (values of 33.20±22.00 mg/dL for cholesterol and 30.21±15.00 g/L for protein). The p value for cholesterol was less than 0.001. Cytology had sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of 56.8%, 100%, 100%, 70.4%, and 78.6% respectively. Using a cut-off limit of 72.7 mg/dL, cholesterol had sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of 94.6%, 94.7%, 94.6%, 94.7% and 94.7% respectively. Ascitic fluid total protein had sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of 37.8%, 86.8%, 73.7%, 58.9%, and 62.7% respectively. Cholesterol was more sensitive than protein and cytology in the differentiating malignant from non-malignant ascites. Conclusion: It was concluded that measurement of cholesterol in ascitic fluid can differentiate between malignant and non-malignant ascites, and can supplement cytology in the differential diagnosis of ascites.