© 2003 BMJ Publishing Group Ltd & Association of Clinical Pathologists
ECHO
Diagnosing intra-abdominal malignancy
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Cytology testing of ascitic fluid may be of limited usefulness in the detection and management of malignancy. Initial assessment should instead concentrate on a thorough history with examination, which should then direct any further laboratory assessment, with cell count and differential, albumin, and culture being mandatory. Additionally serum albumin should be obtained to calculate the serum-ascites albumin gradient as an important determinate of the differential count.
A literature search and retrospective audit was conducted for a major English teaching hospital. Of 276 samples sent for assessment, 45 female and three male specimens were found to contain malignant cells. Of these, 85% (n = 41) were ovarian in origin. Of the remaining 228 specimens (from 84 male and 108 female patients), 220 were reported to have no evidence of malignancy and eight to be inadequate. In this group, the results of 35 (19%) patients were found to be false negatives, and
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