Role of peritoneal ultrasonography and ultrasound-guided fine needle aspiration cytology/biopsy of extravisceral masses in the diagnosis of ascites of undetermined origin |
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| Authors: | Maha Hasab Allah Zakaria A. Salama Aly El-Hindawy Nabil Al Kady |
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| Affiliation: | 1. Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;2. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;3. Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;2. Gastrointestinal Cancer Research Laboratory, Division of Gastroenterology, Baylor Research Institute and Charles A Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, USA;1. Department of Surgery, Institut Claudius Regaud, Toulouse, France;2. Department of Obstetrics and Gynaecology, McGill University, Montreal, Quebec, Canada;3. Departement of Adult Medical Oncology, Centre Léon-Bérard, President of the GINECO Group,Lyon;4. Department of Surgery, Institut de Cancérologie de l''Ouest, Nantes;5. Department of Obstetrics and Gynaecology, Centre Hospitalier, La Rochelle;6. Department of Anesthesiology, HopitalTenon, Paris;7. Beauregard Hospital, Marseille;8. Department of Obstetrics and Gynaecology, Hopital Tenon, Paris;9. Department of Pathology, University Hospital, Lyon;10. Department of Oncology, Institut Claudius Regaud, Toulouse;11. Department of Surgery, University Hospital, Lyon;12. Department of Radiotherapy, Institut Gustave Roussy, Villejuif;13. Department of Oncology, Centre François Baclesse, Caen;14. Division of Gynaecologic Surgery, Hopital Européen Georges Pompidou, Paris;15. Division of Gynaecologic Surgery, Hopital Pitié-Salpétrière, Paris;16. Departments of Oncology;17. Surgery, Institut Gustave Roussy, Villejuif;18. Department of Surgery, Institut Bergonié, Bordeaux;19. Departments of Radiology;20. Gynaecological Oncology, Centre Oscar Lambret, Lille, France |
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| Abstract: | ![]()
Background and study aimsAscites may be of undetermined origin despite comprehensive study. This study aimed to assess the accuracy and safety of conventional and interventional high-frequency peritoneal ultrasound in the diagnosis of patients with ascites of unclear origin.Patients and methodsA total of 62 patients were prospectively enrolled; they underwent conventional (3.5–5 MHz) and high-frequency (6–8 MHz) transabdominal peritoneal ultrasound to suggest the nature of ascites supplemented by fine needle aspiration cytology (FNAC) of ascites and/or core biopsy of the omentum or other extra-visceral masses for final histopathologic diagnosis. Laparoscopy or laparotomy was needed if biopsy was inconclusive.ResultsUltrasound-guided procedures were diagnostic in 55 (87.7%) patients. Thirty-six (58.1%) were benign, of whom 86% had tuberculous peritonitis, 26 (41.9%) were malignant, of whom 76.9% had peritoneal metastasis. High-frequency ultrasound was able to propose ultrasonographic criteria in a trial to diagnose the nature of ascites. Our proposed ultrasonographic criteria were based on the amount and texture of ascites in addition to the omental and mesenteric features. These were able to suggest the diagnosis with 80.7% sensitivity for malignant ascites and 75% specificity for benign ascites. Moreover, histopathological examination of tissues obtained by ultrasound-guided procedures increased the sensitivity to 88.5% and the specificity to 88.9% in diagnosing malignant and benign disease, respectively, with an overall diagnostic accuracy of 88.6%. These procedures were considered to be safe as only one major (haemoperitoneum) and two minor complications (temporary ascitic fistula) were reported.ConclusionHigh-frequency peritoneal ultrasound together with the minimally invasive ultrasound-guided FNAC/biopsy of extra-visceral lesions may be considered an effective and safe tool in the diagnosis of ascites of undetermined origin. |
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