Pleural fluid biochemical analysis: the past, present and future

Abstract

Identifying the cause of pleural effusion is challenging for pulmonologists. Imaging, biopsy, microbiology and biochemical analyses are routinely used for diagnosing pleural effusion. Among these diagnostic tools, biochemical analyses are promising because they have the advantages of low cost, minimal invasiveness, observer independence and short turn-around time. Here, we reviewed the past, present and future of pleural fluid biochemical analysis. We reviewed the history of Light’s criteria and its modifications and the current status of biomarkers for heart failure, malignant pleural effusion, tuberculosis pleural effusion and parapneumonic pleural effusion. In addition, we anticipate the future of pleural fluid biochemical analysis, including the utility of machine learning, molecular diagnosis and high-throughput technologies. Clinical Chemistry and Laboratory Medicine (CCLM) should address the topic of pleural fluid biochemical analysis in the future to promote specific knowledge in the laboratory professional community.

Development and validation of a machine learning model for differential diagnosis of malignant pleural effusion using routine laboratory data

“…According to Light’s criteria, 26 a subgroup of exudative PE cases was identified, comprising 541 MPE patients and 521 BPE patients. In this subset, the XGBoost model consistently displayed exceptional diagnostic capabilities in detecting exudative MPE, with AUC values of 0.936, 0.948, and 0.919 in the training, validation, and testing cohorts, respectively, surpassing PF CEA, serum CEA, and the PF/serum CEA (Figure 5 and Table 5).…”

“…Despite this, the clinical presentation of MPE can be similar to that of BPE, complicating the accurate identification of 27,28 Many studies have also explored the potential diagnostic value of biomarkers in the identification of MPE from BPE, including traditional TMs and some novel molecules. 26 The conventional TMs often exhibited high specificity and low sensitivity. 7,29 For instance, Fan et al 30 found that PF CEA had the largest AUC (0.890) with a high specificity (95.5%); however, with a low sensitivity (74.1%).…”

Value of human epididymis secretory protein 4 in differentiating malignant from benign pleural effusion: an analysis of two cohorts

“…Systematic reviews and meta-analyses reveal that these tumor markers have high specificity (>0.90) for MPE but their sensitivity is only around 0.50. 13,[15][16][17][18] Therefore, developing novel tumor markers to improve the diagnostic accuracy for MPE remains valuable.…”

Long‐term stability of pleural fluid carcinoembryonic antigen and its effect on the diagnostic accuracy for malignant pleural effusion

“…In addition, special training is needed for thoracoscopy, limiting its application in remote areas. By contrast, pleural fluid tumor markers are alternative tools for diagnosing MPE because they have the advantages of being relatively inexpensive, easy to perform, have short turn‐around time and allow major objectiveness in clinical judgment 17,18 …”

“…By contrast, pleural fluid tumor markers are alternative tools for diagnosing MPE because they have the advantages of being relatively inexpensive, easy to perform, have short turn-around time and allow major objectiveness in clinical judgment. 17,18 Serum carcinoembryonic antigen (CEA) is a widely used tumor marker with diagnostic utility in various cancers. CEA in pleural fluid can be used as a diagnostic marker for MPE.…”