Clinical value of tumour markers and serum-ascites albumin gradient in the diagnosis of malignancy-related ascites.
To determine the clinical value of tumour markers in the diagnosis of malignancy-related ascites (not including hepatocellular carcinoma), serum and ascitic fluid levels of carcinoembryonic antigen, cancer antigen 125, carbohydrate antigen 19-9, tissue polypeptide antigen and serum-ascites albumin gradient were determined in 66 patients with cirrhotic ascites, 28 patients with hepatocellular carcinoma and ascites, and 29 patients with malignancy-related ascites. Three tumour markers and serum-ascites albumin gradient showed significant difference between patients with malignancy-related ascites and those without: serum carcinoembryonic antigen (26.4 +/- 31.5 vs 4.8 +/- 4.6 ng/mL, P < 0.01), ascitic fluid carcinoembryonic antigen (118.4 +/- 196.5 vs 2.0 +/- 1.4 ng/mL, P < 0.01), ascitic fluid carbohydrate antigen 19-9 (12,933 +/- 25,496 vs 23 +/- 67 U/mL, P < 0.01) and serum-ascites albumin gradient (1.1 +/- 0.4 vs 2.0 +/- 0.4 g/dL, P < 0.01). At the best cut-off levels chosen from near 95% of the data in those without malignancy-related ascites, the sensitivity, specificity and accuracy to diagnose malignancy-related ascites were, respectively, 65.5%, 93.6%, 87.0% using serum carcinoembryonic antigen > or = 10 ng/mL; 69.0%, 94.7%, 88.6% using ascitic fluid carcinoembryonic antigen > or = 5 ng/mL; 65.5%, 93.6%, 87.0% using ascitic fluid carbohydrate antigen 19-9 > or = 50 U/mL; 62.1%, 98.9%, 90.2% using serum-ascites albumin gradient < 1.1 g/dL. Although serum-ascites albumin gradient offered the best diagnostic accuracy and specificity, its sensitivity was not good enough. Our study indicates that serum-ascites albumin gradient and tumour markers are not sensitive parameters in the diagnosis of malignancy-related ascites.
Chen
S J
SJ
Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China.
Wang
S S
SS
Lu
C W
CW
Chao
Y
Y
Lee
F Y
FY
Lee
S D
SD
Wu
S L
SL
Cherng
K L
KL
Lo
K J
KJ
D001201:Ascites / Q000175:diagnosis / Q000209:etiology*; D001202:Ascitic Fluid / Q000737:chemistry*; D014408:Biomarkers, Tumor / Q000032:analysis*; D006528:Carcinoma, Hepatocellular / Q000150:complications; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015592:Immunoradiometric Assay; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000556:secondary; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis*
D014408:Biomarkers, Tumor; D012709:Serum Albumin