Endoscopic ultrasonography (EUS) in the detection of malignant ascites: Is it a marker of peritoneal carcinomatosis (PC)?

B. J. Pollack, A. Chak, M. Canto, G. S. Cooper, M. V. Sivak

Research output: Contribution to journalArticle

Abstract

Introduction: Ascites is thought to be predictive of PC in patients with abdominal malignancy. Limited data are available on the significance of ascites detected at EUS. Aims: 1) To determine if ascites detected at EUS correlates with pathologically proven carcinomatosis. 2) To compare the sensitivity, specificity and accuracy of EUS versus CT in the detection of malignant ascites. Methods: A single expert endosonographer blindly reviewed EUS videotapes of malignant gastric and pancreatic lesions for the presence of ascites. Patients with a history of cirrhosis, congestive heart failure requiring diuretics, ascites detected by examination and patients who did not undergo surgical exploration were excluded. The results were retrospectively correlated with operative findings and surgical pathology and compared to CT results. PC was defined by peritoneal or omental implants and/or malignant peritoneal fluid. Results: 26 patients with gastric {n = 8) and pancreatic (n=181 carcinomas were studied. At surgery, carcinomatosis was found in 11 cases: peritoneal implants-6, omental involvement-4, and malignant peritoneal fluid-1. EUS detected ascites in 8/11 (73%) patients with pathologically proven carcinomatosis, while CT detected ascites in only 2111 (18%) patients. In 3 cases of PC in which EUS was negative, ascites was not detected at the time of surgery. Malignant ascites was detected only in patients with advanced tumors (pathologically-staged: 10 T3, 1 T4). EUS and CT did not detect any gross peritoneal implants, nor did either test detect ascites in patients without carcinomatosis. Detection of Malignant Ascites and Correlation with PC Modality sensitivity Specificity PPV NPV accuracy*EUS 73% 100% 100% 83% 88% CT 18% 100% 100% 61% 64%*(p < .05) Conclusions: 1. Peritoneal fluid detected by EUS is correlated with peritoneal carcinomatosis. 2. EUS is more sensitive and significantly more accurate than CT in detecting peritoneal fluid.

Original languageEnglish (US)
Number of pages1
JournalGastrointestinal endoscopy
Volume43
Issue number4
DOIs
StatePublished - Jan 1 1996
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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