The role of peritoneal biopsy in the diagnosis of ascites

Our plain-English summary of The role of peritoneal biopsy in the diagnosis of ascites, by P.F. Jenkins, M.J. Ward (Postgraduate Medical Journal, 1980).

The study

• Authors: P.F. Jenkins, M.J. Ward
• Journal: Postgraduate Medical Journal
• Published: 1980;56(660):702-3
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Percutaneous biopsies of the peritoneum were obtained in 23 patients with ascites of unknown cause. The only case of tuberculous peritonitis was correctly diagnosed. Peritoneal biopsy provided a diagnosis of malignancy in 6 patients (one lymphoma, one mesothelioma, 4 cases of disseminated carcinoma) but failed to recognize a further 13 cases of disseminated carcinoma. Previous literature is reviewed and the diagnostic usefulness of this procedure is discussed.

In plain English

In this case series from The City Hospital, Nottingham, the authors performed needle biopsy of the peritoneum (the lining of the abdomen) at the bedside on 23 patients with ascites (fluid in the abdomen) of unknown cause, in whom tuberculosis or cancer was suspected. Twelve of the 23 were male, and their average age was 64 years. The article does not discuss asbestos or the patients' work histories. The needle obtained peritoneal tissue every time, and biopsy gave a diagnosis in 8 of the 23 cases. It was diagnostic in 4 of 16 patients with carcinoma. The authors called this 25% rate disappointing but more useful than examining the fluid alone, which suggested carcinoma in only 2 patients. The single cases of tuberculous peritonitis, non-Hodgkin's lymphoma and mesothelioma were each correctly diagnosed by biopsy. The authors wrote that further investigation such as laparotomy was particularly contra-indicated in mesothelioma. They found the procedure easy and safe. The authors concluded that peritoneal biopsy should be used routinely in patients suspected of malignant or tuberculous ascites.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Clinical case series evaluating a diagnostic procedure (percutaneous peritoneal biopsy)
• Who was studied: 23 patients with undiagnosed ascites at The City Hospital, Nottingham, a District General Hospital in the United Kingdom; 12 male; average age 64 years (range 29-80). Study dates not given.
• Exposure: No asbestos or other occupational exposure was studied; the article does not mention asbestos. The subject was a diagnostic procedure: peritoneal biopsy taken with an Abrams pleural biopsy needle under local anaesthetic.
• Main results:
  • Across all 23 patients, peritoneal biopsy was diagnostic in 8, and tissue from the peritoneum was obtained on every attempt.
  • Among patients with carcinoma, biopsy was diagnostic in 4 of 16, which the authors described as a 25% pick-up rate.
  • The one patient with mesothelioma and the one with lymphoma were each correctly diagnosed by peritoneal biopsy. So was the one patient with tuberculous peritonitis.
  • Direct examination of the ascitic fluid suggested carcinoma in only 2 patients.
  • The authors reported that the procedure was easy and safe, with no bleeding encountered.
• The authors' conclusion: The authors concluded that, given its relative ease and safety, peritoneal biopsy should be used routinely at diagnostic paracentesis in all patients suspected of malignant or tuberculous ascites. They also stated that in mesothelioma further investigation such as laparotomy is particularly contra-indicated.

Topics

Medical terms in this study, explained in our Lexicon: Biopsy, Ascites, Peritoneum, Mesothelioma, Carcinoma.

Related studies

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• An unusual case of ascites: pitfalls in diagnosis of malignant peritoneal mesothelioma — J.R. Clark, W.B. Ross (2000)
• Metastatic peritoneal mesothelioma in the setting of recurrent ascites: a case report — V. Samedi, S. White, et al. (2010)
• A Single-Center Experience: The Diagnostic Role of Peritoneoscopy in Patients with Exudative Ascites — B. Abaylı, G. Gençdal (2019)
• Challenging and uncommon diagnosis of long-evolution ascites — M. Gravito-Soares, E. Gravito-Soares, et al. (2017)
• A novel approach: transumbilical endoscopic exploration and biopsy for patients with unknown ascites — Y. Yang, W. Zhang, et al. (2012)

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