Role of ascites adenosine deaminase in differentiating between tuberculous peritonitis and peritoneal carcinomatosis.
OBJECTIVE
To investigate the usefulness of tumor markers and adenosine deaminase in differentiating between tuberculous peritonitis (TBP) and peritoneal carcinomatosis (PC).


METHODS
A retrospective analysis of data was performed on consecutive patients who underwent peritoneoscopic and abdominal computed tomography (CT) evaluations. Among 75 patients at the Seoul National University Hospital from January 2000 to June 2010 who underwent both tests, 27 patients (36.0%) and 25 patients (33.3%) were diagnosed with TBP and PC, respectively. Diagnosis was confirmed by peritoneoscopic biopsy.


RESULTS
Serum c-reactive protein (7.88 ± 6.62 mg/dL vs 3.12 ± 2.69 mg/dL, P = 0.01), ascites adenosine deaminase (66.76 ± 32.09 IU/L vs 13.89 ± 8.95 IU/L, P < 0.01), ascites lymphocyte proportion (67.77 ± 23.41% vs 48.36 ± 18.78%, P < 0.01), and serum-ascites albumin gradient (0.72 ± 0.49 g/dL vs 1.05 ± 0.50 g/dL, P = 0.03) were significantly different between the two groups. Among tumor markers, serum and ascites carcinoembryonic antigen, serum carbohydrate antigen 19-9 showed significant difference between two groups. Abdominal CT examinations showed that smooth involvement of the parietal peritoneum was more common in the TBP group (77.8% vs 40.7%) whereas nodular involvement was more common in the PC group (14.8% vs 40.7%, P = 0.04). From receiver operating characteristic (ROC) curves ascites adenosines deaminase (ADA) showed better discriminative capability than tumor markers. An ADA cut-off level of 21 IU/L was found to yield the best results of differential diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value were 92.0%, 85.0%, 88.5% and 89.5%, respectively.


CONCLUSIONS
Besides clinical and radiologic findings, ascitic fluid ADA measurement is helpful in the differential diagnosis of TBP and PC.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 110-744, South Korea.
Seung Joo
SJ
Kang
Ji Won
JW
Kim
Jee Hyun
JH
Baek
Se Hyung
SH
Kim
Byeong Gwan
BG
Kim
Kook Lae
KL
Lee
Ji Bong
JB
Jeong
Yong Jin
YJ
Jung
Joo Sung
JS
Kim
Hyun Chae
HC
Jung
In Sung
IS
Song
D000243:Adenosine Deaminase / Q000032:analysis*; D000368:Aged; D001201:Ascites / Q000175:diagnosis* / Q000209:etiology; D001202:Ascitic Fluid / Q000201:enzymology*; D014408:Biomarkers, Tumor / Q000032:analysis*; D001706:Biopsy; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis*; D016009:Chi-Square Distribution; D004796:Clinical Enzyme Tests; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000150:complications / Q000175:diagnosis*; D014395:Peritonitis, Tuberculous / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012372:ROC Curve; D056910:Republic of Korea; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D014408:Biomarkers, Tumor; C548482:ADA protein, human; D000243:Adenosine Deaminase