Comparison of Ascitic Fluid Cholesterol and Fibronectin with Conventional Ascitic Protein Values in Differentiating Malignant Ascites from Non malignant Ascites: A Cross-sectional Study

Abstract

Introduction: It is a known clinical problem to differentiate between malignant and non malignant ascites because there is no single routine biochemical laboratory test that can completely distinguish between them. The diagnostic sensitivity of cytological examination is 40%-60%. Aim: To establish the correlation and evaluate the levels of ascitic fluid cholesterol and fibronectin in the differentiation of malignant and non malignant ascites, compared to conventional total protein concentration in ascitic fluid. Materials and Methods: A cross-sectional study included 93 patients with clinically detectable ascites, admitted to the Department of Medicine at SCB Medical College, Cuttack, Odisha, India. Patients over 18 years of age presenting with ascites confirmed clinically or by Ultrasonography (USG) were included. Pregnant patients, those with blunt abdominal injury, those previously diagnosed with cancer and having received anticancer treatment, those who failed to give consent, and critically ill patients were excluded. All patients underwent diagnostic paracentesis, and the ascitic fluid was analysed for gross appearance, cytological examination, and biochemical studies. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 27.0. Results: The study group comprised 47 males and 46 females. The mean age of the study group was 52.25±12.74 years, ranging from 20 to 79 years. The mean ascitic fibronectin concentration in patients with malignant ascites was 64.93±21.41 ng/mL. Using various cutoff values, the diagnostic accuracy of ascitic fluid cholesterol, fibronectin, total protein, Serum Ascites Albumin Gradient (SAAG), and Serum Ascites Cholesterol Gradient (SACG) in differentiating malignancy-related ascitic fluid from non malignant ascites were determined as 98.92%, 97.85%, 56.99%, 52.69%, and 67.74%, respectively. Conclusion: Cholesterol and fibronectin estimations present valuable diagnostic features for differentiation, surpassing the conventional protein, albumin, and SAAG determinations in terms of diagnostic accuracy and cost-effectiveness of the assay

Keywords

• albumin
• carcinoma
• cirrhosis
• serum ascites albumin gradient
• serum ascites cholesterol gradient