Download PDF
Digestive Disease Interventions
DOI: 10.1055/s-0043-1772580
Review Article

Evaluation of Imaging-Guided Peritoneal Biopsy in Diagnosis of Ascites of Unknown Origin

Prof. Nadia Abdelaaty Abdelkader 
1   Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Prof. Mohammed El-Naggar
1   Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Prof. Waheed Tantawy
2   Department of Radiodiagnosis and Interventional Radiology, Ain Shams University, Cairo, Egypt
,
Prof. Mohammad Amin Sakr
1   Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Prof. Eman Abdel-Salam Ibrahim
3   Department of Pathology, Ain Shams University, Cairo, Egypt
,
Mohammed Abo Zaid
1   Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Ahmad F. Sherief
1   Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Assoc. Prof. Ahmed S. Abdelmoaty 
1   Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
› Author Affiliations Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Ascites is a common clinical problem, which can be a result of liver cirrhosis, neoplasm, tuberculous or pyogenic peritonitis, heart failure, nephrosis, and pancreatic disorders. This study aimed to evaluate the role of imaging-guided peritoneal biopsy in the diagnosis of ascites of unknown origin (ascites of local cause). Sixty-three patients with ascites of unknown etiology were included. Abdominal ultrasonography (US) with colored Duplex was performed, followed by laboratory investigations such as, ascitic fluid samples, magnetic resonance imaging, multislice computed tomography (CT), or PET/CT scan (if indicated). Imaging-guided peritoneal biopsy such as US-guided or CT-guided percutaneous peritoneal biopsy (in cases of failure of US-guided technique) of omentum or extravisceral masses was performed. Cytological and histopathological examinations of the tissue specimens were done by a single experienced pathologist. Other more invasive procedures (e.g., laparoscopy) were needed when the imaging-guided biopsy was not diagnostic. Fifty-four patients underwent US-guided biopsies, 48 patients were successfully diagnosed, and other 9 patients underwent CT-guided biopsies (not accessible by US-guided modality); laparoscopy was needed only in 6 patients. Malignant peritoneal pathology was found in 48 patients, while tuberculous peritonitis was diagnosed in 14 patients. Imaging-guided biopsies had perfect sensitivity (100%) and negative predictive value (100%) in differentiating neoplastic lesions. Percutaneous imaging-guided biopsy (US/CT guided) of the peritoneum, omenta, and mesentery has been established as a safe, simple, noninvasive, and well-tolerated procedure with high diagnostic accuracy. It can minimize further unnecessary invasive procedures such as laparoscopy.

Keywords

imaging-guided peritoneal biopsy - ascites of unknown origin - malignant ascites - tuberculous ascites

Authors' Contributions

We declare that all listed authors have made substantial contributions to all of the following three parts of the manuscript:


• Research design, acquisition, analysis, or interpretation of data.


• Drafting the paper or revising it critically.


• Approving the submitted version.




Publication History

Received: 04 July 2022

Accepted: 18 July 2023

Article published online:
16 April 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Matsunaga I, Oka H, Ueda M, Arakawa T, Kobayashi K. Idiopathic colonic phlebitis with massive ascites. Intern Med 1995; 34 (08) 776-781
    CrossrefPubMedSearch in Google Scholar
  • 2 Han CM, Lee CL, Huang KG. et al. Diagnostic laparoscopy in ascites of unknown origin: Chang Gung Memorial Hospital 20-year experience. Chang Gung Med J 2008; 31 (04) 378-383
    PubMedSearch in Google Scholar
  • 3 Beleña JM, Nuñez M. Postoperative complications of laparoscopic surgery. Int J Clin Anesthesiol 2014; 2: 1034
    PubMedSearch in Google Scholar
  • 4 Abdelaal A, Alfkey R, Abdelaziem S. et al. Role of laparoscopic peritoneal biopsy in the diagnosis of peritoneal tuberculosis. A seven-year experience. Chirurgia (Bucur) 2014; 109 (03) 330-334
    PubMedSearch in Google Scholar
  • 5 Hanbidge AE, Lynch D, Wilson SR. US of the peritoneum. Radiographics 2003; 23 (03) 663-684 , discussion 684–685
    CrossrefPubMedSearch in Google Scholar
  • 6 Marin D, Catalano C, Baski M. et al. 64-Section multi-detector row CT in the preoperative diagnosis of peritoneal carcinomatosis: correlation with histopathological findings. Abdom Imaging 2010; 35 (06) 694-700
    CrossrefPubMedSearch in Google Scholar
  • 7 Memel DS, Dodd III GD, Esola CC. Efficacy of sonography as a guidance technique for biopsy of abdominal, pelvic, and retroperitoneal lymph nodes. AJR Am J Roentgenol 1996; 167 (04) 957-962
    CrossrefPubMedSearch in Google Scholar
  • 8 Wang J, Gao L, Tang S. et al. A retrospective analysis on the diagnostic value of ultrasound-guided percutaneous biopsy for peritoneal lesions. World J Surg Oncol 2013; 11: 251
    CrossrefPubMedSearch in Google Scholar
  • 9 Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension. Hepatology 2010; 51: 1-16
    PubMedSearch in Google Scholar
  • 10 Rumack CM, Wilson SR, William CJ. Diagnostic Ultrasound. 3rd ed.. Elsevier Mosby; 2005: 504
    Search in Google Scholar
  • 11 Charoensak A, Nantavithya P, Apisarnthanarak P. Abdominal CT findings to distinguish between tuberculous peritonitis and peritoneal carcinomatosis. J Med Assoc Thai 2012; 95 (11) 1449-1456
    PubMedSearch in Google Scholar
  • 12 Allah MH, Salama ZA, El-Hindawy A, Al Kady N. Role of peritoneal ultrasonography and ultrasound-guided fine needle aspiration cytology/biopsy of extravisceral masses in the diagnosis of ascites of undetermined origin. Arab J Gastroenterol 2012; 13 (03) 116-124
    CrossrefPubMedSearch in Google Scholar
  • 13 Salman MA, Salman AA, Hamdy A. et al. Predictive value of omental thickness on ultrasonography for diagnosis of unexplained ascites, an Egyptian centre study. Asian J Surg 2020; 43 (01) 13-19
    CrossrefPubMedSearch in Google Scholar
  • 14 Menzies RI, Fitzgerald JM, Mulpeter K. Laparoscopic diagnosis of ascites in Lesotho. Br Med J (Clin Res Ed) 1985; 291 (6493): 473-475
    CrossrefPubMedSearch in Google Scholar
  • 15 Diop AD, Fontarensky M, Montoriol PF, Da Ines D. CT imaging of peritoneal carcinomatosis and its mimics. Diagn Interv Imaging 2014; 95 (09) 861-872
    CrossrefPubMedSearch in Google Scholar
  • 16 Srivastava U, Almusa O, Tung KW, Heller MT. Tuberculous peritonitis. Radiol Case Rep 2015; 9 (03) 971
    CrossrefPubMedSearch in Google Scholar
  • 17 Mamo JP, Brij SO, Enoch DA. Abdominal tuberculosis: a retrospective review of cases presenting to a UK district hospital. QJM 2013; 106 (04) 347-354
    CrossrefPubMedSearch in Google Scholar
  • 18 Wang SB, Ji YH, Wu HB. et al. PET/CT for differentiating between tuberculous peritonitis and peritoneal carcinomatosis: The parietal peritoneum. Medicine (Baltimore) 2017; 96 (02) e5867
    CrossrefPubMedSearch in Google Scholar
  • 19 Tao L, Ning H-J, Nie H-M, Guo XY, Qin SY, Jiang HX. Diagnostic value of adenosine deaminase in ascites for tuberculosis ascites: a meta-analysis. Diagn Microbiol Infect Dis 2014; 79 (01) 102-107
    CrossrefPubMedSearch in Google Scholar
  • 20 Goerg C, Schwerk WB. Malignant ascites: sonographic signs of peritoneal carcinomatosis. Eur J Cancer 1991; 27 (06) 720-723
    CrossrefPubMedSearch in Google Scholar
  • 21 Uzunkoy A, Harma M, Harma M. Diagnosis of abdominal tuberculosis: experience from 11 cases and review of the literature. World J Gastroenterol 2004; 10 (24) 3647-3649
    CrossrefPubMedSearch in Google Scholar
  • 22 Akhan O, Pringot J. Imaging of abdominal tuberculosis. Eur Radiol 2002; 12 (02) 312-323
    CrossrefPubMedSearch in Google Scholar
  • 23 Lee DH, Lim JH, Ko YT, Yoon Y. Sonographic findings in tuberculous peritonitis of wet-ascitic type. Clin Radiol 1991; 44 (05) 306-310
    CrossrefPubMedSearch in Google Scholar
  • 24 Batra A, Gulati MS, Sarma D, Paul SB. Sonographic appearances in abdominal tuberculosis. J Clin Ultrasound 2000; 28 (05) 233-245
    CrossrefPubMedSearch in Google Scholar
  • 25 Kedar RP, Shah PP, Shivde RS, Malde HM. Sonographic findings in gastrointestinal and peritoneal tuberculosis. Clin Radiol 1994; 49 (01) 24-29
    CrossrefPubMedSearch in Google Scholar
  • 26 Jain R, Sawhney S, Bhargava DK, Berry M. Diagnosis of abdominal tuberculosis: sonographic findings in patients with early disease. AJR Am J Roentgenol 1995; 165 (06) 1391-1395
    CrossrefPubMedSearch in Google Scholar
  • 27 Pereira JM, Madureira AJ, Vieira A, Ramos I. Abdominal tuberculosis: imaging features. Eur J Radiol 2005; 55 (02) 173-180
    CrossrefPubMedSearch in Google Scholar
  • 28 Souza FF, Mortelé KJ, Cibas ES, Erturk SM, Silverman SG. Predictive value of percutaneous imaging-guided biopsy of peritoneal and omental masses: results in 111 patients. AJR Am J Roentgenol 2009; 192 (01) 131-136
    CrossrefPubMedSearch in Google Scholar
  • 29 Que Y, Wang X, Liu Y, Li P, Ou G, Zhao W. Ultrasound-guided biopsy of greater omentum: an effective method to trace the origin of unclear ascites. Eur J Radiol 2009; 70 (02) 331-335
    CrossrefPubMedSearch in Google Scholar
  • 30 Gottlieb RH, Tan R, Widjaja J, Fultz PJ, Robinette WB, Rubens DJ. Extravisceral masses in the peritoneal cavity: sonographically guided biopsies in 52 patients. AJR Am J Roentgenol 1998; 171 (03) 697-701
    CrossrefPubMedSearch in Google Scholar
  • 31 Spencer JA, Swift SE, Wilkinson N, Boon AP, Lane G, Perren TJ. Peritoneal carcinomatosis: image-guided peritoneal core biopsy for tumor type and patient care. Radiology 2001; 221 (01) 173-177
    CrossrefPubMedSearch in Google Scholar
  • 32 Souza FF, Mortelé KJ, Cibas ES, Erturk SM, Silverman SG. Predictive value of percutaneous imaging-guided biopsy of peritoneal and omental masses: results in 111 patients. AJR Am J Roentgenol 2009; 192 (01) 131-136
    CrossrefPubMedSearch in Google Scholar
  • 33 Vadvala HV, Furtado VF, Kambadakone A, Frenk NE, Mueller PR, Arellano RS. Image-guided percutaneous omental and mesenteric biopsy: assessment of technical success rate and diagnostic yield. J Vasc Interv Radiol 2017; 28 (11) 1569-1576
    CrossrefPubMedSearch in Google Scholar
  • 34 Hewitt MJ, Anderson K, Hall GD. et al. Women with peritoneal carcinomatosis of unknown origin: efficacy of image-guided biopsy to determine site-specific diagnosis. BJOG 2007; 114 (01) 46-50
    CrossrefPubMedSearch in Google Scholar