Identifying Malignant Pleural Effusion by A Cancer Ratio (Serum LDH: Pleural Fluid ADA Ratio)

Verma, Akash; Abisheganaden, John; Light, Richard W.

doi:10.1007/s00408-015-9831-6

Cited by 65 publications

(94 citation statements)

References 25 publications

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“…Similar to other studies we found that larger amount of fluid drained, higher pleural fluid protein and higher pleural fluid LDH were associated with a higher risk of MPE [28]. LDH is found in numerous clinical conditions and had been reported as a marker of poor outcome in cancer patients [29].…”

Section: Discussionsupporting

confidence: 79%

Sensitivity of Initial Thoracentesis for Malignant Pleural Effusion Stratified by Tumor Type in Patients with Strong Evidence of Metastatic Disease

et al. 2018

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Background: Thoracentesis with cytological examination of pleural fluid is the initial test of choice for evaluation of pleural effusions in patients with suspected malignant pleural effusion (MPE). There is limited data on the sensitivity of thoracentesis stratified by tumor type. A better understanding of stratified sensitivities is of clinical interest, and may guide early and appropriate referral for pleural biopsy. Objective: The primary objective was sensitivity of thoracentesis with pleural fluid cytology stratified by tumor type. Methods: This is a retrospective cohort study of consecutive patients with a solid tumor malignancy with proven or strong suspicion for metastatic disease with new pleural effusions that underwent an initial thoracentesis. Only patients with metastatic disease were included. Results: Of the 725 patients examined, 63% had pleural fluid cytology positive for malignancy. Sensitivity of thoracentesis varied from a low of 0.38 (95% CI 0.13–0.68) in head and neck malignancy, 0.38 (95% CI 0.15–0.65) in sarcoma, and 0.53 (95% CI 0.34–0.72) in renal cancer to a high of 93 (95% CI 88–97) in breast cancer, and 100 (95% CI 0.82–100) in pancreatic cancer. Factors associated with an increased risk of MPE included larger amount of fluid drained (p = 0.014) and higher pleural fluid protein (p = 0.002). The only factor associated with decreased risk of MPE if first cytology was negative for malignancy was the presence of contralateral effusion (p = 0.005). Conclusions: Sensitivity of thoracentesis for solid tumors varies significantly depending on the type of tumor and is lowest in those with sarcomas, head and neck malignancies, and renal cell cancers.

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Section: Discussionsupporting

confidence: 79%

Sensitivity of Initial Thoracentesis for Malignant Pleural Effusion Stratified by Tumor Type in Patients with Strong Evidence of Metastatic Disease

et al. 2018

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“…These findings were slightly lower than the previous results of our retrospective study on cancer ratio where this cut-off level allowed distinction of MPE from nonmalignant pleural effusion with the sensitivity and specificity of 0.98 and 0.94 and PLR and NLR of 32.6 and 0.03, respectively [11]. …”

Section: Discussioncontrasting

confidence: 76%

“…We calculated and analysed three ratios:The ratio between serum LDH and pleural ADA: this was called “cancer ratio” as per our previous publication [11]. This was calculated for prospective validation of our previous retrospectively published findings.…”

Section: Methodsmentioning

confidence: 99%

“…Such a marker not only may provide an early signal toward malignant nature of pleural effusion, but can potentially serve as a “forewarning” for patients with negative cytology who are subsequently found to have MPE. Our previous report of a retrospective analysis demonstrated that a “cancer ratio” (serum LDH : pleural ADA ratio) yielded sensitivity and specificity of 0.98 and 0.94, respectively, at the cut-off level of >20 for identifying MPE [11]. …”

Section: Introductionmentioning

confidence: 99%

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Differentiating Malignant from Tubercular Pleural Effusion by Cancer Ratio Plus (Cancer Ratio: Pleural Lymphocyte Count)

Verma

Dagaonkar

Marshall

et al. 2016

Canadian Respiratory Journal

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Background. We performed prospective validation of the cancer ratio (serum LDH : pleural ADA ratio), previously reported as predictive of malignant effusion retrospectively, and assessed the effect of combining it with “pleural lymphocyte count” in diagnosing malignant pleural effusion (MPE). Methods. Prospective cohort study of patients hospitalized with lymphocyte predominant exudative pleural effusion in 2015. Results. 118 patients, 84 (71.2%) having MPE and 34 (28.8%) having tuberculous pleural effusion (TPE), were analysed. In multivariate logistic regression analysis, cancer ratio, serum LDH : pleural fluid lymphocyte count ratio, and “cancer ratio plus” (ratio of cancer ratio and pleural fluid lymphocyte count) correlated positively with MPE. The sensitivity and specificity of cancer ratio, ratio of serum LDH : pleural fluid lymphocyte count, and “cancer ratio plus” were 0.95 (95% CI 0.87–0.98) and 0.85 (95% CI 0.68–0.94), 0.63 (95% CI 0.51–0.73) and 0.85 (95% CI 0.68–0.94), and 97.6 (95% CI 0.90–0.99) and 94.1 (95% CI 0.78–0.98) at the cut-off level of >20, >800, and >30, respectively. Conclusion. Without incurring any additional cost, or requiring additional test, effort, or time, cancer ratio maintained and “cancer ratio plus” improved the specificity of cancer ratio in identifying MPE in the prospective cohort.

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“…In our cases, though, ADA levels in pleural fluid were low and rather ineffective in the initial diagnostic assessment of our patients. On the other hand, in a recently published study the cancer ratio (serum LDH/pleural ADA ratio) (36) has been evaluated in diagnosing MPE, with sensitivity and specificity also in 90s. Nevertheless, further studies are warranted.…”

Section: Discussionmentioning

confidence: 99%

A potential role for VEGF in the diagnostic approach of pleural effusions

et al. 2016

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Identifying Malignant Pleural Effusion by A Cancer Ratio (Serum LDH: Pleural Fluid ADA Ratio)

Cited by 65 publications

References 25 publications

Sensitivity of Initial Thoracentesis for Malignant Pleural Effusion Stratified by Tumor Type in Patients with Strong Evidence of Metastatic Disease

Sensitivity of Initial Thoracentesis for Malignant Pleural Effusion Stratified by Tumor Type in Patients with Strong Evidence of Metastatic Disease

Differentiating Malignant from Tubercular Pleural Effusion by Cancer Ratio Plus (Cancer Ratio: Pleural Lymphocyte Count)

A potential role for VEGF in the diagnostic approach of pleural effusions

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