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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.
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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

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