الفهرس 
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Abstract
Ascitic fluid analysis represents one of the most important procedures in evaluating the patients with ascites. Many biochemical parameters in ascitic fluid had been analyzed in attempt to differentiate between malignant and non malignant ascites.
Ascitic fluid cholesterol and CEA have very promising results in diagnosing the malignant nature of ascites. In this study we examined 40 patients with ascites (20 with malignant ascites and 20 with non malignant ascites) to measure and compare the diagnostic efficacy of ascitic fluid cholesterol and CEA in diagnosing malignant ascites. Also to detect the diagnostic efficacy of test association of both ascitic fluid cholesterol and CEA in differentiating malignant from non malignant ascites. Malignancy was documented by the detection of malignant cells in ascitic fluid cytology.
Ascitic fluid of all patients was subjected to biochemical examination to evaluate LDH, total proteins, albumin, glucose, WBCs, cholesterol and CEA. Also serum cholesterol, CEA and alphafetoprotein were evaluated. All these parameters (except ascitic WBCs and ascitic fluid glucose) were higher in patients with malignant ascites than those with non malignant ascites.
Also when we calculated the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of different ascitic fluid parameters in predicting malignant ascites, at a certain cut off value for each parameter the results were as follows; ascitic fluid LDH recorded sensitivity (95%), specificity (55%), positive predictive value (68%), negative predictive value (92%) and diagnostic accuracy (75%) at 119 IU/l as a cut off value. Ascitic fluid total proteins recorded the same sensitivity (95%), higher specificity (75%), higher positive predictive value (79%), nearly the same negative predictive value (94%) and higher diagnostic accuracy (85%) at 2 gm/dl as a cut off value. Ascitic fluid cholesterol recorded the same sensitivity (95%), same specificity as ascitic fluid total proteins (75%), higher positive predictive value (82%), nearly the same negative predictive value (89%) and the same diagnostic accuracy as ascitic total proteins (85%) at 26 mg/dl as a cut off value. Ascitic fluid CEA recorded lower sensitivity (80%), highest specificity (100%), highest positive predictive value (100%), nearly the same negative predictive value (83%) and the same diagnostic accuracy as ascitic cholesterol (90%) at 6.55 ng/ml as a cut off value.
Also when we used test association of both ascitic fluid cholesterol and ascitic fluid CEA in diagnosing malignant ascites, the sensitivity of diagnosis malignant ascites increased from 95% (with ascitic fluid cholesterol alone) and 80% (with ascitic fluid CEA alone) to 100% (with both), while the specificity for diagnosis of malignant ascites changed from 75% (with ascitic fluid cholesterol alone) and 100 (with ascitic fluid CEA alone) to 75% (with both). So test association of both ascitic fluid cholesterol and CEA would increase the diagnostic efficacy for diagnosis of malignant ascites.