Prospective Study To Determine the Volume of Pleural Fluid Required To Diagnose Malignancy

Swiderek, Jennifer; Morcos, Samer; Donthireddy, Vijayalakshmi; Surapaneni, Rajesh; Jackson-Thompson, Vicki; Schultz, Lonni; Kini, Sudha R.; Kvale, Paul A.

doi:10.1378/chest.09-0641

Cited by 105 publications

(87 citation statements)

References 16 publications

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“…However, scarcity of free malignant cells in pleural fluid samples remains a serious challenge. A prospective study demonstrated that at least 150 mL of pleural fluid is needed for analysis with both cytology and cell block [32]. Consequently, ≥150 mL pleural was routinely collected in all patients in the present study.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Utility of Pleural Fluid Cell Block versus Pleural Biopsy Collected by Flex-Rigid Pleuroscopy for Malignant Pleural Disease: A Single Center Retrospective Analysis

et al. 2016

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BackgroundSome trials recently demonstrated the benefit of targeted treatment for malignant disease; therefore, adequate tissues are needed to detect the targeted gene. Pleural biopsy using flex-rigid pleuroscopy and pleural effusion cell block analysis are both useful for diagnosis of malignancy and obtaining adequate samples. The purpose of our study was to compare the diagnostic utility between the two methods among patients with malignant pleural disease with effusion.MethodsData from patients who underwent flex-rigid pleuroscopy for diagnosis of pleural effusion suspicious for malignancy at the National Cancer Center Hospital, Japan between April 2011 and June 2014 were retrospectively reviewed. All procedures were performed under local anesthesia. At least 150 mL of pleural fluid was collected by pleuroscopy, followed by pleural biopsies from the abnormal site.ResultsThirty-five patients who were finally diagnosed as malignant pleural disease were included in this study. Final diagnoses of malignancy were 24 adenocarcinoma, 1 combined adeno-small cell carcinoma, and 7 malignant pleural mesothelioma (MPM), and 3 metastatic breast cancer. The diagnostic yield was significantly higher by pleural biopsy than by cell block [94.2% (33/35) vs. 71.4% (25/35); p = 0.008]. All patients with positive results on cell block also had positive results on pleural biopsy. Eight patients with negative results on cell block had positive results on pleural biopsy (lung adenocarcinoma in 4, sarcomatoid MPM in 3, and metastatic breast cancer in 1). Two patients with negative results on both cell block and pleural biopsy were diagnosed was sarcomatoid MPM by computed tomography-guided needle biopsy and epithelioid MPM by autopsy.ConclusionPleural biopsy using flex-rigid pleuroscopy was efficient in the diagnosis of malignant pleural diseases. Flex-rigid pleuroscopy with pleural biopsy and pleural effusion cell block analysis should be considered as the initial diagnostic approach for malignant pleural diseases presenting with effusion.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Utility of Pleural Fluid Cell Block versus Pleural Biopsy Collected by Flex-Rigid Pleuroscopy for Malignant Pleural Disease: A Single Center Retrospective Analysis

et al. 2016

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“…[26] A 60 mL sample of PF provides greater diagnostic yield for MPE than 10 mL, but more than 50 mL does not seem to improve diagnostic sensitivity. [27] Diagnostic yield depends on the type of tumor (higher for adenocarcinomas) and is about 60% (range, 40%-87%). [28] However, a second cytology may increase diagnostic sensitivity by 27%,[29] if several 100 mL is drained in the initial thoracentesis, since the number of fresh malignant cells exfoliated increases in the second.…”

Section: Thoracentesismentioning

confidence: 99%

Pleural procedures in the management of malignant effusions

Ferreiro¹,

Suárez-Antelo

Valdés³

2017

Ann Thorac Med

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Malignant pleural effusion (MPE) is common in clinical practice, and despite the existence of studies to guide clinical decisions, it often poses diagnostic and therapeutic dilemmas. Once it is diagnosed, median survival does not usually exceed 6 months. The management of these patients focuses on symptom relief since no treatments have been shown to increase survival to date. Conversely, poor management can shorten survival. The approach must be multidisciplinary and allow for individualized care. Initial diagnostic procedures should be minimally invasive and, according to the results and other factors, procedures of increasing complexity will be selecting. Likewise, the treatment of MPEs should be individualized according to factors such as type of tumor, patient functional status, means available, benefits of each procedure, or life expectancy. Currently, treatment seems to tend toward less interventional approaches, in which patients can be managed on an outpatient basis, thus minimizing both the discomfort that more aggressive approaches involve and the costs of care associated with this disease. This article reviews the pleural procedures employed in the management of MPEs with special emphasis on the indication for each one, its usefulness, benefits, and complications.

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“…Therefore, there is a major limitation to applying this method in all pleural effusions as we may miss a good number of them. However, by using cytospin and/or cell blocks of pleural fluid for cytopathological diagnosis, in the case of lung adenocarcinoma pleural effusion, we may increase our diagnostic yield [34]. Many of the authors argued that to perform tissue studies is difficult, because of the low quantity of pleural tissue they can obtain for molecular studies, already of limited sufficiency for accurate histological diagnosis.…”

Section: Epidermal Growth Factor Receptor Pathwaymentioning

confidence: 99%

Pleural Effusion in Lung Cancer: More Questions than Answers

Froudarakis

2012

Respiration

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Lung cancer remains the most common fatal malignancy, despite more aggressive therapies. Few patients will survive 5 years, as up to 80% of the patients will present with advanced-stage disease at diagnosis. Chemotherapy offers little benefit in terms of median survival and disease-free survival in patients with advanced-stage non-small-cell lung carcinoma (NSCLC). In the last decade, the development of new targeted therapies based on the better understanding of different paths of carcinogenesis has given new hope to both physicians and patients. Metastatic pleural effusion from lung cancer has a particularly poor prognosis, and in NSCLC it is actually reclassified as stage IV disease. A possible explanation of this observation is differences in the genomics between primary tumors and metastasis, leading to possible different therapeutic approaches with novel molecular therapies in this patient population. The current review aims to summarize the actual situation of research in pleural disease due to lung carcinoma in relation to novel targeted therapies tested in this patient population.

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Prospective Study To Determine the Volume of Pleural Fluid Required To Diagnose Malignancy

Cited by 105 publications

References 16 publications

Diagnostic Utility of Pleural Fluid Cell Block versus Pleural Biopsy Collected by Flex-Rigid Pleuroscopy for Malignant Pleural Disease: A Single Center Retrospective Analysis

Diagnostic Utility of Pleural Fluid Cell Block versus Pleural Biopsy Collected by Flex-Rigid Pleuroscopy for Malignant Pleural Disease: A Single Center Retrospective Analysis

Pleural procedures in the management of malignant effusions

Pleural Effusion in Lung Cancer: More Questions than Answers

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