[Ascitic fluid: the value of various biological tests in the differential diagnosis between cirrhotic and neoplastic ascites].

The authors have analyzed sixty cases of ascites including twenty of neoplastic origin and thirty-six of cirrhotic origin in order to evaluate the usefulness of several laboratory tests for the differential diagnosis of ascites. The tests which gave more than 85% diagnostic accuracy were ascitic fluid concentrations of fibronectin and total protein, serum-ascites gradients of albumin and total protein concentrations, ascitic fluid concentrations of albumin and cholesterol. The last three tests gave a diagnostic accuracy of more than 92% at discriminant levels of 3.8 gr/dl, 1.6 gr/dl and 60 mg/dl, respectively. For these six tests, neoplastic ascites due to liver metastasis had values intermediate between cirrhotic ascites and neoplastic ascites due to peritoneal carcinomatosis. A serum-ascites albumin gradient of more than 1.1 gr/dl was indicative of portal hypertension in cirrhotic patients; the total protein serum-ascites gradient had a better diagnostic accuracy. Flow cytometry had less diagnostic accuracy than cytology; moreover, all cases with abnormal flow cytometry were already recognized by cytology.