Clinical Significance Of Incorporating Ascites Measurement In Diagnosis Of Ovarian Epithelial Carcinomas

The most common sign of ovarian carcinoma is ascites. It is very important for treatment of ovarian carcinoma to identify the nature of ascites before operation. But a reliable method for the diagnosis of benign from malignant ascites is not existed. The present study was performed to see whether the diagnostic accuracy of ovarian epithelial carcinomas could be improved by incorporating ascites measurement of CA125, LDH, cancer cells and chromosomes.ObjectiveTo evaluate the significance of incorporating ascites measurement of CA125, LDH, cancer cells and chromosomes in patients with ovarian epithelial cancer.Materials and MethodsAscites samples were obtained pre-operatively from the 55 cases admitted in the Department of Gynecology and Gastroenterology, the First Affiliated Hospital of China Medical University, in the 12-month period of 2002-2003. The cases were divided into two groups; 35 with ovarian epithelial cancer, 20 with benign disease. Ascites samples were aspirated at the time of laparotomy or laparocente-sis. CA125 was measured by an enzyme-linked immuno sorbent assay. The ascites CA125 reference limit of 250Ku/L was used for the ascites samples. Ascites LDH was measured by an automatic biochemistry analysis apparatus. The ascites LDH reference limit of 410U/L was used for the ascites samples. The routine preparation for cytologic evoluation was regarded as positive when cells definedas malignant was found. For the ascites chromosomes measurement, samples were considered positive if the abnormal chromosomes and cellular fission were found, meanwhile the sum total of diploid chromosomes and hypodiploid chromosomes were exceeded 50%. All analysis was carried out using SPSS statistical software.Results1. CA125 and LDH levels in ascites patients with ovarian epithelial cancer were significantly higher than those in patients with benign cases. (P <0.001)2. The positive rate of chromosomes in ascites patients with ovarian epithelial cancer were significantly higher than cancer cells in ascites in patients with benign cases. (P < 0. 01)3. Of the 35 cases of ovarian epithelial carcinomas, sensitivity of ascites was 94. 3% specificity of cytology was 100% ; accuracy of ascites chromosomes was 89. 1%.4. The combination CA125 and chromosomes positive was found to have 95% specificity, 80% sensitivity and 87.7% accuracy in patients with ovarian epithelial carcinomas.5. Cytology combining with ascites LDH or CA125 has no difference in the diagnosis of ovarian epithelial carcinomas.6. Of the 11 cases of ovarian epithelial carcinomas, which were negative for ascites cytology, 81. 8% were positive for ascites CA125 and 45. 8% were positive for combination CA125 and chromosomes.DiscussionAscites CA125 level was the most sensitive maker for the diagnosis of ovarian cancer. CA125level of ascites patients with ovarian epithelial cancer was significantly higher than that in patients with benign cases. 85. 7% (12/14) of patients suffering from tuberculous peritonitis were positive in ascites CA125 measurement. The highest diagnostic accuracy of ovarian epithelial cancer was a-chieved by raising the limit to 1000KU/L.Increasing level of ascites LDH has been reported in 30% - 70% of malignant cases. Of the 35 cases of ovarian epithelial carcinomas 82. 9% were positive for ascites LDH. Ascites LDH demonstrated lower diagnostic sensitivity than CA125. However, of the 20 cases of benign cases, 10% were positive for ascites LDH. Yet, ascites LDH demonstrated higher diagnostic specificity in differentiation between malignant and non-malignant ascites.A positive cytology result confirmed a malignant aetiology in ascites; in the right hands it had a specificity of 100% and had strong relationship with the stage and prognosis of ovarian carcinomas. This result owed that ascites samples were obtained from advanced-stage ovarian cancer patients. In order to raising the positive rate of ascites cytology repeat cytology was necessary.Of the 35 cases of ovarian epitheh'al c...