Utility of Ascitic Fluid Cholesterol Levels in Alignant

The differential diagnosis of malignant ascites by traditional methods has been recently challenged. We had studied 100 cases of ascites (27 were of malignant ascites) to evaluate the role of ascitic fluid cholesterol levels as a marker in malignancy.100 cases of ascites were studied with regard to SAAG, ascitic fluid cholesterol levels and fluid cytology. FNAC & biopsy was performed wherever mandatory to confirm the role of biochemical marker. We found The sensitivity & specificity of raised ascitic fluid cholesterol levels in diagnosing malignant ascites was found to be 88.88% & 100% respectively (cut-off value 70mg/dl), which was proved by cytology & biopsy (p = 0.005 was significant).So to conclude Raised ascitic fluid cholesterol levels can be used as an excellent marker in malignancy, the efficacy of which was proved on cytology & biopsy. INTRODUCTION Ascites is one of the most common clinical problems confronting a clinician and ascitic fluid analysis is the most effective way to diagnose it (Beg et al., 2001). The earlier approach in differentiating causes of ascites was based on the concept of transudate (ascitic fluid proteins <2.5 gm/dl) and exudate (ascitic fluid proteins >2.5 gm/dl). This concept has recently been challenged (Akriviadis et al., 1996) as it has certain limitations: i) The ascitic fluid total protein of most cardiac ascites samples (traditionally expected to be transudate) was high. ii) Ascitic fluid total proteins of most spontaneously infected samples (traditionally expected to be exudate) was low (Beg et al., 2001; Runyon et al., 1992) iii) The efficacy has also been challenged in conditions like prolonged diuretic therapy and, sometimes, in normal ascitic fluid too. Moreover, it offers little insight into the pathophysiology of as cites (Beg et al., 2001).The difference between serum & ascites albumin concentration (SAAG) is thought to directly reflect the colloid osmotic pressure gradient & indirectly the degree of portal hypertension (Bandar et al., 1997) Thus it has been widely suggested that SAAG is an excellent marker of portal hypertension than ascitic fluid protein concentration (Pare et al., 1983). Patients with a gradient > 1.1 gm/dl have portal hypertension while those with a gradient of < 1.1 gm/dl do not. The accuracy of such determinations is 97% (Runyon et al., 1992). However, SAAG is not able to differentiate between malignant ascites & tuberculous ascites (Alba et al., 1995), Fluid cytology has low sensitivity for malignancy as the differentiation between reactive atypical mesothelial cells and malignant cells is sometimes difficult (Jain et al., 1966) So there is a need for more specific & a highly sensitive new marker in presumptive diagnosis of ascites. Ascitic fluid cholesterol level, with a diagnostic sensitivity of 89.65% & specificity of 100% (Sood et al., 1995 & Jungst et al., 1992) promises to be one of them. An enhanced movement of plasma lipoproteins into peritoneal cavity could cause the raised cholesterol levels. It has also been suggested that a minor fraction of cholesterol in malignant ascites might be derived from cell membranes and thus contribute to elevated ascitic fluid concentrations in malignant ascites (Jungst et al., 1992) According to recent studies, using a cut-off value of 70 mg/dl, the specificity is 100% and sensitivity is 96% in diagnosis of malignancy (Rana et al., 2005). Thus, the present study was undertaken to evaluate the diagnostic utility of ascitic fluid cholesterol levels in diagnosis of malignant ascites to prove the efficacy of these parameters with the help of cytology & biopsy. International Journal of Basic and Applied Medical Sciences ISSN: 2277-2103 (Online) An Online International Journal Available at http://www.cibtech.org/jms.htm 2012 Vol. 2 (3) September December, pp.79-82/Ingle and Ingle