A Prospective Study of the Volume of Pleural Fluid Required for Accurate Diagnosis of Malignant Pleural Effusion

Pearls and myths in pleural fluid analysis

“…The findings did not support the authors' previous results; they found an incremental yield with increasing volumes of fluid analysis (respective sensitivities were 49%, 63% and 69%). Another prospective analysis of 44 patients concluded that PF samples greater than 50 mL did not increase diagnostic yield 6 . Cytological tests were positive for malignancy in 55% of the cases, regardless of whether the sample analysed was 50 mL or a larger volume 6 .…”

“…Another prospective analysis of 44 patients concluded that PF samples greater than 50 mL did not increase diagnostic yield 6 . Cytological tests were positive for malignancy in 55% of the cases, regardless of whether the sample analysed was 50 mL or a larger volume 6 . In our experience, the sensitivity of as little as 4 mL of PF for diagnosing 466 pleural malignancies was 56.4% (95% CI: 52–61%), 7 which is in accordance with the figures reported in other studies 4,6 .…”

Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010

“…There is conflicting evidence regarding the optimum volume of pleural fluid for diagnosis of malignancy; sensitivity depends on the cellularity of the sample and processing technique as well as volume submitted 23 24. It is sensible to send as large a volume as possible from the 50–60 ml sample obtained following diagnostic aspiration as other tests only require small volumes.…”

“…Swiderek et al found that submission of a 60 ml pleural fluid sample produced a significantly better sensitivity for the diagnosis of malignancy than 10 ml, but previous studies have shown that sending volumes >50 ml did not improve the diagnostic yield 23 24. The evidence for sending large volumes of pleural fluid is not strong enough to justify the increased risk of complications associated with the use of a venflon and three-way tap for initial diagnostic aspiration.…”

The yield of different pleural fluid volumes forMycobacterium tuberculosisculture: Table 1

“…Mycobacterial cultures from pleural fluid have a reported average yield of 24%–58%, which is the highest when liquid culture media are used 1 2. Recent evidence suggests that a higher volume of pleural fluid submitted for cytological analysis or for bacterial culture does not increase the rate of detection of malignant cells or bacteria, respectively 3 4. We compared the yields of 100 ml or 5 ml of pleural fluid inoculated in liquid culture medium in 77 patients with a high suspicion of pleural tuberculosis.…”