Background: The differentiation of the non-malignant ascites (NMA), and malignancy-related ascites (MA) in early phases, with subsequent appropriate management remains a considerable clinical challenge.
Objective: This study aimed to investigate the possible diagnostic value of the level of telomerase enzyme in ascitic fluid in discrimination between MA and NMA.
Patients and Methods: The study included 117 patients, divided into two groups: 45 (38.5%) in group I with NMA as a control group and 72 (61.5%) in group II with MA. Group II was subdivided into group IIa including patients with primary hepatocellular carcinoma, and IIb that included patients with other non-hepatic malignancies. All patients were subjected to complete history taking, cytological examination, and biochemical analysis of the level of telomerase enzyme in ascitic fluid in comparison to cytological examination of ascetic fluid and the serum level of some specific traditional tumor markers (CA19.9, CEA, CA125, and alpha fetoprotein).
Results: In the malignant group, telomerase level was higher than cut off value (1.2 ng/ml) in (34/40) 85.0 % of group IIa, and (25/32) 78.1% in group IIb, while it was high in (14/45) 31.1% of control group. Cytological examination was positive in (6/40) 15.0 % of group IIa and (12/32) 37.5% of group IIb.   Moreover, in group IIa, telomerase at cut off level of ≥ 5.25 ng/ml and serum alpha-fetoprotein (AFP) at level of ≥ 210.8 ng/ml demonstrated a sensitivity of 88.4%, 77.1%, and a specificity of 67.7%, 77.3%, respectively.
Conclusion: The level of telomerase enzyme could be a useful tool in evaluating the diagnostic performance of cytological examination especially if used in combination with another more specific tumor marker and may provide a better differentiation between MA and NMA.