Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jun 14, 2012; 18(22): 2837-2843
Published online Jun 14, 2012. doi: 10.3748/wjg.v18.i22.2837
Role of ascites adenosine deaminase in differentiating between tuberculous peritonitis and peritoneal carcinomatosis
Seung Joo Kang, Ji Won Kim, Jee Hyun Baek, Se Hyung Kim, Byeong Gwan Kim, Kook Lae Lee, Ji Bong Jeong, Yong Jin Jung, Joo Sung Kim, Hyun Chae Jung, In Sung Song
Seung Joo Kang, Joo Sung Kim, Hyun Chae Jung, In Sung Song, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 110-744, South Korea
Ji Won Kim, Byeong Gwan Kim, Kook Lae Lee, Ji Bong Jeong, Yong Jin Jung, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul 157-707, South Korea
Jee Hyun Baek, Se Hyung Kim, Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, South Korea
Author contributions: Kang SJ and Kim JW designed the study and wrote the manuscript; Baek JH and Kim SH reviewed the all abdomen computed tomographys in this study; Kim BG, Lee KL, Jeong JB and Jung YJ co-ordinated and provided the patient’s data; and Kim JS, Jung HC and Song IS analyzed the data and involved in editing the manuscript.
Correspondence to: Ji Won Kim, MD, PhD, Associate Professor, Department of Internal Medicine, Seoul National University Borame Hospital, 395, Shindaebang 2-Dong, Dongjak-Gu, Seoul 157-707, South Korea. giwkim@hanmail.net
Telephone: +82-2-8402712 Fax: +82-2-8310174
Received: November 17, 2011
Revised: January 16, 2012
Accepted: April 13, 2012
Published online: June 14, 2012
Abstract

AIM: To investigate the usefulness of tumor markers and adenosine deaminase in differentiating between tuberculous peritonitis (TBP) and peritoneal carcinomatosis (PC).

METHODS: A retrospective analysis of data was performed on consecutive patients who underwent peritoneoscopic and abdominal computed tomography (CT) evaluations. Among 75 patients at the Seoul National University Hospital from January 2000 to June 2010 who underwent both tests, 27 patients (36.0%) and 25 patients (33.3%) were diagnosed with TBP and PC, respectively. Diagnosis was confirmed by peritoneoscopic biopsy.

RESULTS: Serum c-reactive protein (7.88 ± 6.62 mg/dL vs 3.12 ± 2.69 mg/dL, P = 0.01), ascites adenosine deaminase (66.76 ± 32.09 IU/L vs 13.89 ± 8.95 IU/L, P < 0.01), ascites lymphocyte proportion (67.77 ± 23.41% vs 48.36 ± 18.78%, P < 0.01), and serum-ascites albumin gradient (0.72 ± 0.49 g/dL vs 1.05 ± 0.50 g/dL, P = 0.03) were significantly different between the two groups. Among tumor markers, serum and ascites carcinoembryonic antigen, serum carbohydrate antigen 19-9 showed significant difference between two groups. Abdominal CT examinations showed that smooth involvement of the parietal peritoneum was more common in the TBP group (77.8% vs 40.7%) whereas nodular involvement was more common in the PC group (14.8% vs 40.7%, P = 0.04). From receiver operating characteristic (ROC) curves ascites adenosines deaminase (ADA) showed better discriminative capability than tumor markers. An ADA cut-off level of 21 IU/L was found to yield the best results of differential diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value were 92.0%, 85.0%, 88.5% and 89.5%, respectively.

CONCLUSION: Besides clinical and radiologic findings, ascitic fluid ADA measurement is helpful in the differential diagnosis of TBP and PC.

Keywords: Tuberculous peritonitis, Peritoneal carcinomatosis, Adenosine deaminase, Peritoneoscopy