EUS-guided paracentesis for the diagnosis of malignant ascites.
BACKGROUND
EUS and EUS-guided fine-needle aspiration (EUS-FNA) have well-defined roles in the diagnosis and staging of GI and pancreaticobiliary malignancy. Malignant ascites usually represents peritoneal carcinomatosis, increases disease stage, and portends a poor prognosis. There are limited data regarding the yield of EUS-guided paracentesis (EUS-P) for the diagnosis of malignant ascites.


OBJECTIVE
To determine the usefulness of EUS-P for the diagnosis of malignant ascites.


METHODS
Prospective case series.


METHODS
Tertiary referral academic center.


METHODS
Those presenting for EUS examination for suspected or proven malignancy over a 16-month period were evaluated prospectively for the presence of ascites.


METHODS
EUS-P was performed via a transgastric or transduodenal approach if ascites was detected.


METHODS
Sensitivity, specificity, positive predictive value, and negative predictive value of EUS-P for diagnosing malignant ascites.


RESULTS
Six hundred twenty-nine patients were studied. Twenty-five patients with ascites who met inclusion criteria comprised the study cohort. The mean volume of ascites aspirated was 6.8 mL (range, 1-20 mL). Sixty-four percent (16 of 25) of EUS-P samples revealed malignant cytology. Of the group with negative ascitic cytology, 67% (6 of 9) had a proven malignancy. There was one false-negative cytology result. The sensitivity, specificity, positive predictive value, and negative predictive value of EUS-P for diagnosing malignant ascites was 94%, 100%, 100%, and 89%, respectively. The complication rate was 4%; 1 patient developed bacterial peritonitis after EUS-P.


CONCLUSIONS
The study did not address cost savings in patient care based on the diagnosis of malignant ascites.


CONCLUSIONS
EUS-P is highly sensitive and specific for diagnosing malignant ascites. The finding of malignant ascites significantly alters patient management, so an active search for ascites and use of EUS-P should be incorporated into the diagnosis and staging of upper GI and pancreaticobiliary malignancy.
Kaushik
Neeraj
N
Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Khalid
Asif
A
Brody
Debra
D
McGrath
Kevin
K
D000368:Aged; D001201:Ascites / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D044963:Biopsy, Fine-Needle / Q000379:methods; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019152:Paracentesis / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000556:secondary; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity