Key result
A peritoneal nodule size of more than 5 mm on CECT abdomen as a sign of malignancy had a sensitivity of 93% and a specificity of 83%.
Why the study?
In a minority of patients, the aetiology of ascites remains undetected after routine clinical, laboratory, and imaging investigations, and the diagnostic value of peritoneal nodules on CECT abdomen needed evaluation.
Does CECT abdomen evaluation of peritoneal nodule size accurately diagnose the etiology of ascites of unknown origin?
Observational (n=52)
No
Does CECT abdomen evaluation of peritoneal nodule size accurately diagnose the etiology of ascites of unknown origin?
Peritoneal nodules >5 mm detected on CECT abdomen provide high sensitivity (93%) and specificity (83%) for diagnosing malignancy in patients with ascites of unknown origin.
May support CECT nodule size >5 mm to suggest malignant ascites; leaves open prospective validation before changing practice.
Introduction: The aetiology of ascites can be established in a majority of patients with routine clinical examination and conventional laboratory and imaging investigations; but in a minority, the cause may remain undetected even after these examinations. This ascites is termed as ascites of unknown origin. The Contrast Enhanced Computed Tomography (CECT) abdomen of these patients sometimes shows peritoneal nodules which can be useful to establish diagnosis. Aim: To evaluate the diagnostic value of peritoneal nodules detected on CECT abdomen in the management of ascites of unknown origin. Materials and Methods: This retrospective study was conducted in Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India on the data retrieved from the medical records of the patients between January 2019 to January 2021. These patients had already been vainly investigated with basic clinical, laboratory and diagnostic ultrasound examinations for the aetiology of ascites. All the patients who were diagnosed to have peritoneal nodules on CECT abdomen and later underwent laparoscopic tissue diagnosis of these peritoneal nodules were included in the study. The sizes of the peritoneal nodules and the distribution of the pathology were collected from CECT abdomen reports and compared them with the histopathology findings. Statistical analysis and plotting of the Receiver Operating Characteristic (ROC) curve were done using Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Fifty-two patients of ascites of unknown origin with peritoneal nodules were included in the study. Of the total, 36 (69.2%) patients were males and 16 (30.8%) were females. Mean age of the patients was 48 years (22 to 74 years). Tissue diagnosis of the peritoneal nodules revealed that majority of the patients had carcinomatosis peritonei (88.5%) while a minority had tuberculosis (11.5%). A nodule size of more than 5 mm as a sign of malignancy on CECT abdomen had a sensitivity of 93% and a specificity of 83%. Based on the tissue diagnosis of the peritoneal nodules these patients were treated with antituberculosis drugs for tuberculous abdomen and chemotherapy for carcinomatosis peritonei. Conclusion: Detection of peritoneal nodules on CECT abdomen can be helpful in guiding the clinician for further management of ascites of unknown origin.
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Jukuri et al. (2022) conducted an observational in Ascites of unknown origin (n=52). Peritoneal nodules > 5 mm on CECT abdomen vs. Histopathology (reference standard) was evaluated on Diagnosis of carcinomatosis peritonei. A peritoneal nodule size of more than 5 mm on CECT abdomen as a sign of malignancy had a sensitivity of 93% and a specificity of 83%.
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