-
Acta Cytologica 2020The cytologic evaluation of serous effusions may be challenging for a number of reasons. Distinction of benign, reactive conditions from malignancy represents the main... (Review)
Review
The cytologic evaluation of serous effusions may be challenging for a number of reasons. Distinction of benign, reactive conditions from malignancy represents the main focus when examining these specimens. The morphologic diagnosis of malignancy may be difficult due to the relative paucity of abnormal cells. In other situations, cellularity is not an issue, but the ability to confidently identify a second, foreign (i.e., tumor) population within a background mesothelial cells on the basis of cytomorphologic features alone may pose problems. Cases with definitive morphologic evidence of malignancy may require additional studies in order to determine the tumor subtype and, in the case of carcinoma, the primary site of origin. Cases in which a definitive and precise diagnosis of malignancy is made may be optimal candidates for further molecular testing in order to gain prognostic information and guide personal therapeutic decisions. Finally, while an inflammatory or infectious condition can be suggested on the basis of cellular components and associated background elements, the identification of causative agent(s) may be difficult without additional studies. In all of these situations, the use of ancillary studies and techniques is critical; their utility and appropriate application are the subject of this review.
Topics: Ascitic Fluid; Cytodiagnosis; Diagnosis, Differential; Humans; Mesothelioma; Molecular Diagnostic Techniques; Pleural Effusion, Malignant; Sensitivity and Specificity
PubMed: 31018204
DOI: 10.1159/000496568 -
The Journal of the Association of... Jan 2023Spontaneous bacterial peritonitis (SBP) is a common and serious complication in cirrhosis patients with an incidence and mortality of about 30% and 25% respectively in... (Observational Study)
Observational Study
INTRODUCTION
Spontaneous bacterial peritonitis (SBP) is a common and serious complication in cirrhosis patients with an incidence and mortality of about 30% and 25% respectively in hospitalised patients. Currently the diagnostic criteria is presence of >250 neutrophils per microlitre in ascitic fluid, but these facilities are not available at all timings and often the results are delayed. A rapid and bedside test is needed for diagnosis of SBP which aids in timely treatment.Dipsticks based on detection of leukocyte esterase in fluid are available everywhere and widely used for detecting urinary tract infection. In this study we aimed to find out the diagnostic utility of these dipsticks in SBP for immediate diagnosis.
MATERIALS
An observational cross sectional study was conducted among 75 patients with cirrhosis suspected of having SBP clinically. Relevant investigations, diagnostic paracentesis and dipstick test of ascitic fluid was done. The patients were divided into two groups with and without SBP.The ascitic fluid neutrophil count and dipstick results were compared in both groups.
RESULT
26 patients (34.6%) had SBP out of total 75 patients. AKI and hepatic encephalopathy were significantly higher in SBP patients (53% and 50% respectively in SBP patients; 28% and 18% in patients without SBP). Sensitivity and specificity of dipstick test with cutoff of more than 1+ was 96% and 75% respectively; with cutoff of more than 2 was 80% and 91% respectively.
CONCLUSION
The dipstick can be used as a bedside maneuver for immediate diagnosis of SBP. Having a good negative predictive value, it can also be used to exclude SBP, thus avoiding unnecessary antibiotics administration. References Koulaouzidis A. Diagnosis of spontaneous bacterial peritonitis: an update on leucocyte esterase reagent strips. World J Gastroenterol 2011;17(9):1091-1094. Oey RC, Kuiper JJ, Van Buuren HR, et al. Reagent strips are efficient to rule out spontaneous bacterial peritonitis in cirrhotics. Neth J Med 2016;74(6):257-261.
Topics: Humans; Reagent Strips; Cross-Sectional Studies; Bacterial Infections; Ascitic Fluid; Peritonitis; Liver Cirrhosis
PubMed: 37116047
DOI: No ID Found -
European Journal of Gastroenterology &... Aug 2019Patients with ascites are at a higher risk for associated of on top bacterial infections with subsequent life-threatening complications. We aimed to evaluate CD64,... (Comparative Study)
Comparative Study Observational Study
AIM
Patients with ascites are at a higher risk for associated of on top bacterial infections with subsequent life-threatening complications. We aimed to evaluate CD64, calprotectin, and microRNA-155 (miR-155) levels as diagnostic markers of spontaneous bacterial peritonitis (SBP) and the effect of using more than one use on the same spot over their diagnostic efficiency.
PATIENTS AND METHODS
An observational comparative study included 103 patients with ascites admitted to the Tropical Medicine Department, Mansoura University Hospital, Egypt, divided into two groups: case group (64 patients) with ascites with SBP and control group (39 patients) with decompensated cirrhotic non-SBP ascites. Twenty milliliters of ascetic fluid was obtained from all participants for bacterial culture, and assessment of calprotectin and miR-155, in addition to 2 ml blood for the CD64 marker expression assay by a flowcytometer.
RESULTS
The sensitivity and specificity of CD64 expression assay were 95.3 and 92.3%, respectively, area under the curve (AUC)=0.93, whereas those of ascetic fluid calprotectin and miR-155 were 87.5 and 82.1%, AUC=0.90 and 95.3 and 97.4%, with AUC of 0.95. Combined blood CD64 and ascetic fluid calprotectin had a diagnostic accuracy of 0.988 for blood CD64 and ascetic fluid miR-155, AUC=0.991, and that for ascetic fluid calprotectin and miR-155 was 0.988. On using the three studied markers together, the diagnostic accuracy was the best recorded, AUC=0.994. P values were less than 0.001.
CONCLUSION
CD64, calprotectin, and miR-155 were good diagnostic markers of SBP and on using this combination, greater efficiency in diagnosis was achieved.
Topics: Ascitic Fluid; Bacteria; Bacterial Infections; Biomarkers; Enzyme-Linked Immunosorbent Assay; Female; Flow Cytometry; Follow-Up Studies; Humans; Leukocyte L1 Antigen Complex; Male; MicroRNAs; Middle Aged; Peritonitis; Prospective Studies; Receptors, IgG
PubMed: 31116113
DOI: 10.1097/MEG.0000000000001443 -
Cancer Cytopathology Aug 2018Pleural, pericardial, and peritoneal effusion specimens present diagnostic challenges and clinical opportunities for cytology. For the patient, these specimens may be... (Review)
Review
Pleural, pericardial, and peritoneal effusion specimens present diagnostic challenges and clinical opportunities for cytology. For the patient, these specimens may be the first diagnosis of malignancy or the first sign of disease recurrence. This review aims to provide useful approaches with which to resolve key difficulties in cytologic diagnosis through the use of ancillary studies, focusing on immunohistochemistry. These approaches are suggested in concert with clinical, radiographic, and morphologic findings. The differentiation of reactive mesothelial cells from malignant mesothelioma and adenocarcinoma is a recurring theme, and Wilms tumor 1 (WT1)/AE1/AE3, claudin 4, and BRCA1-associated protein 1 (BAP1) immunostains are useful new tools in the armamentarium. A targeted workup is suggested for patients with no known primary site or with multiple prior malignancies. Molecular and other biomarker testing can be performed on even modestly cellular fluid specimens and may allow patients to benefit from targeted therapy without the need for additional tissue biopsies. Cancer Cytopathol 2018;000:000-000. © 2018 American Cancer Society.
Topics: Ascitic Fluid; Biomarkers; Cytodiagnosis; Humans; Pericardial Effusion; Pleural Effusion, Malignant
PubMed: 30156768
DOI: 10.1002/cncy.22021 -
Archives of Pathology & Laboratory... Sep 2020The incidence and types of malignancies in effusion cytology are largely limited to studies performed in the 1970s through the 1990s.
CONTEXT.—
The incidence and types of malignancies in effusion cytology are largely limited to studies performed in the 1970s through the 1990s.
OBJECTIVE.—
To examine how the incidence of different types of malignancies in effusions has changed with time.
DESIGN.—
A computerized search for fluid cytology from 2000 through 2016 (database included age, gender, cytologic diagnosis, and type of malignancy) was performed, and all cases were reviewed.
RESULTS.—
Of 30 085 effusion specimens, 3285 (11%) were positive for malignancy (2175 pleural, 955 peritoneal, and 155 pericardial). Of those, 1023 (31%) had known primary sites (648 pleural, 267 peritoneal, and 108 pericardial). Malignancy was more common in females than males in both pleural (15% versus 9%) and peritoneal (14% versus 5%) effusions (P < .001). The most common metastatic tumors in pleural fluid were lung for males and breast for females; in peritoneal fluid, hematolymphoid for males and Müllerian tumors for females; in pericardial fluid, lung for both genders. Among invasive mammary carcinomas, lobular carcinoma tended to metastasize to peritoneal fluid, whereas ductal carcinoma tended to metastasize to pleural fluid (P < .001). Plasma cell neoplasms metastasized to pleural and pericardial but not peritoneal fluid (P = .002).
CONCLUSIONS.—
Although pulmonary and Müllerian tumors continue to be the most common origin of metastasis in pleural and peritoneal fluid for males and females, respectively, the frequencies for other malignancies have changed. Familiarity with the more common sites of metastasis in effusion cytology is important, especially in patients with unknown primary, as this will be valuable in judicious triaging of specimens for ancillary studies.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ascitic Fluid; Child; Child, Preschool; Cytodiagnosis; Female; Humans; Incidence; Male; Middle Aged; Neoplasms; Pericardial Effusion; Pleural Effusion; Retrospective Studies; Young Adult
PubMed: 31913661
DOI: 10.5858/arpa.2019-0429-OA -
Current Research in Translational... Nov 2020Spontaneous bacterial peritonitis (SBP) is a potentially lethal complication of ascites. The inflammatory response is very intense in case of SBP despite low...
BACKGROUND
Spontaneous bacterial peritonitis (SBP) is a potentially lethal complication of ascites. The inflammatory response is very intense in case of SBP despite low concentration of bacteria in the ascitic fluid with IL-17A overproduced by intestinal Paneth cells and may have role in host immune defense and inflammatory response.
AIMS
To study the diagnostic performance of serum and ascitic fluid IL-17A as a marker of SBP and its correlation with renal function.
METHODS
120 cirrhotic patients including 80 patients with HCV-induced cirrhotic ascites but not with SBP and 40 patients with HCV-induced cirrhotic ascites with SBP were recruited. Serum and ascitic fluid IL17A were measured before and after treatment.
RESULTS
The mean serum and ascitic fluid levels of IL-17 in cirrhotic patients with SBP were significantly higher than in patients with cirrhosis without SBP (p < 0.001). Also, we found significant decline in both serum and ascitic fluid IL17 levels with successful treatment of SBP (p < 0.001). The sensitivity and specificity of serum IL17 was 100 % when using 92 pg/mL as cutoff. Meanwhile, sensitivity and specificity of ascitic fluid IL-17were 100 % when using 132 pg/mL as cutoff.
CONCLUSIONS
IL-17 could be used as a possible diagnostic biomarker for SBP especially in culture negative and non-neutrocytic SBP and in monitoring therapeutic response. Also, it was shown to be related to hepatic and renal functions deterioration.
Topics: Ascites; Ascitic Fluid; Biomarkers; Egypt; Hepatitis C; Humans; Interleukin-17; Liver Cirrhosis; Peritonitis; Sensitivity and Specificity
PubMed: 32620468
DOI: 10.1016/j.retram.2020.03.001 -
Methods in Molecular Biology (Clifton,... 2019There is limited information regarding the biobanking of pleural and peritoneal fluids that might supplement storage of pulmonary and thoracic tissue biospecimens. Such... (Review)
Review
There is limited information regarding the biobanking of pleural and peritoneal fluids that might supplement storage of pulmonary and thoracic tissue biospecimens. Such fluids are sometimes collected for clinical analyses and may have uses that obviate or supplement tissue samples. There has been a growing interest in using liquid biopsies as they are less invasive and may be amenable to analyses that guide targeted therapies. Integrating cytology and biobanking approaches, we describe techniques that may be used for collecting and banking pleural and peritoneal fluids.
Topics: Ascitic Fluid; Biological Specimen Banks; Humans; Specimen Handling; Tissue Banks
PubMed: 30539441
DOI: 10.1007/978-1-4939-8935-5_13 -
Digestive Diseases (Basel, Switzerland) 2021Malignant ascites results from imbalance between protein in the peritoneal cavity and absorption of fluids via the lymphatic system. More than 20 interleukins (ILs) are...
INTRODUCTION
Malignant ascites results from imbalance between protein in the peritoneal cavity and absorption of fluids via the lymphatic system. More than 20 interleukins (ILs) are known to play an important role in the protection against tumors.
MATERIALS AND METHODS
Ascitic fluid IL-1B, IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ levels were assessed in 45 patients with liver cirrhosis and ascites as judged by histopathological and ultrasonographic findings. They were divided into 2 groups according to presence of hepatic focal lesions. Ten patients with focal hepatic lesions were randomly selected and subjected to analysis of serum levels of IL-2 and IL-10.
RESULTS
Ascitic fluid IL-4, IL-6 and IL-10 levels were found to be significantly higher in patients with hepatocellular carcinoma (HCC) than patients with cirrhosis. TNF-α, and IFN-γ were also found to be higher in HCC than patients with cirrhosis but with no significance. On the other hand, there was no significant difference in levels of IL-1B and IL-2 between the 2 groups. Ascitic fluid IL-2 and IL-10 levels were found to be higher in ascitic fluid than in serum of the same patients.
CONCLUSION
Ascitic fluid levels of IL-4, IL-6 and IL-10 are higher in HCC patients than patients with cirrhosis alone. Levels of ascitic fluid IL-2 and IL-10 proved to be a better prognostic tool than their levels in sera of the same patients. To conclude, patients with cirrhosis may be subjected to scheduled examination of ascitic fluid cytokines to predict transformation into HCC.
Topics: Ascites; Ascitic Fluid; Carcinoma, Hepatocellular; Cytokines; Humans; Liver Cirrhosis; Liver Neoplasms; Prognosis
PubMed: 33440370
DOI: 10.1159/000514356 -
Fertility and Sterility Oct 2023To propose a standardized protocol for peritoneal free fluid and leukocyte sample collection in women with endometriosis suitable for biomedical research on the basis of...
OBJECTIVE
To propose a standardized protocol for peritoneal free fluid and leukocyte sample collection in women with endometriosis suitable for biomedical research on the basis of the surgical procedure, the clinical and technical conditions, and the quality of the samples obtained.
DESIGN
Video showing the step-by-step collection procedure and the suitability of samples obtained for biomedical research.
SUBJECTS
This study included 103 women with confirmed endometriosis by pathology analysis, who signed informed consent and were recruited from the Hospital "Virgen de la Arrixaca", Murcia, Spain. The study was approved by the Ethics Committee of University of Murcia (CEI 3156/2020).
MAIN OUTCOME MEASURES
We analyzed the presence of free fluid in the peritoneal cavity and its relationship with hormonal treatment intake. In addition, the presence of blood contamination, the number of viable leukocytes and macrophages in free peritoneal fluid and lavages as well as their relationship with the lavage volume used, the body mass index, and the age of patients were analyzed.
RESULTS
The presence of free peritoneal fluid, in which cells and molecules could be quantified, was scarce in the patients (21%), and it was not significantly related to hormonal treatment intake. The cell viability was higher than 98% in all collected samples; although 54% showed good quality and enough cellularity to be used in biomedical research, 40% were contaminated with blood and 6% had low cellularity. The number of leukocytes and macrophages recovered from the peritoneal lavages correlated positively with the lavage volume used and negatively with the body mass index and was independent of the age of the patients.
CONCLUSION
We describe a standardized step-by-step procedure for peritoneal fluid and leukocyte collection in women with endometriosis, suitable for biomedical research, taking into account that not all women present free fluid in the peritoneal cavity. We propose to increase the lavage volume recommended by the World Endometriosis Research Foundation from 10 mL to at least 40 mL of sterile saline solution and its mobilization for at least 30 seconds within the peritoneal cavity, especially in patients with higher body mass index, to improve the efficiency of the procedure.
Topics: Humans; Female; Endometriosis; Ascitic Fluid; Leukocytes; Peritoneum; Macrophages
PubMed: 37392781
DOI: 10.1016/j.fertnstert.2023.06.030 -
Arquivos de Gastroenterologia 2022The role of ascitic and serum levels of various tumour biomarkers in the discrimination of cause of ascites is not well established.
BACKGROUND
The role of ascitic and serum levels of various tumour biomarkers in the discrimination of cause of ascites is not well established.
OBJECTIVE
To evaluate the role of serum and ascitic levels of tumor biomarkers (CA 72-4, CA 19-9, CEA and CA 125) in discrimination of cause of ascites.
METHODS
A prospective study was conducted in consecutive patients presenting with ascites. Serum and ascitic levels of CA 19-9, CA 125, CA 72-4 and carcinoembryonic antigen (CEA) were determined at the presentation. The patients with cirrhotic ascites, tuberculous peritonitis (TBP) and peritoneal carcinomatosis (PC) were eventually included in analysis.
RESULTS
Of the 93 patients (58 males, mean age 47 years) included, the underlying cause was cirrhosis in 31, PC in 42 and peritoneal tuberculosis in 20. The best cutoff for discriminating benign and malignant ascites for serum CEA, CA 19-9 and CA 72-4 were 6.7 ng/mL, 108 IU/mL and 8.9 IU/mL, respectively. The best cutoff for discriminating benign and malignant ascites for ascitic CA 125, CEA, CA 19-9 and CA 72-4 were 623 IU/mL, 8.7 ng/mL, 33.2 IU/mL and 7 IU/mL, respectively.
CONCLUSION
The performance of single biomarker for the prediction of underlying PC is low but a combination of serum CA 19-9 and CA 72-4 best predicted the presence of peritoneal carcinomatosis.
Topics: Ascites; Ascitic Fluid; Biomarkers, Tumor; Carcinoembryonic Antigen; Female; Humans; Male; Middle Aged; Peritoneal Neoplasms; Prospective Studies
PubMed: 35830029
DOI: 10.1590/S0004-2803.202202000-37