Role of Common Investigations in Aetiological Evaluation of Exudative Pleural Effusions

Maji, Arnab Kumar; Maikap, Malay Kumar; Jash, Debraj; Kaushik, Sushmita; Kundu, Anjan; Saha, Debabrata; Banerjee, Sourindra Nath; Patra, Anupam

doi:10.7860/jcdr/2013/6738.3476

Cited by 9 publications

(7 citation statements)

References 16 publications

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“…1 About 40% of exudative pleural effusions are related to lung cancer 2−4 and about 55% are related to pulmonary tuberculosis. 5 Clinically, both conditions showed overlapping symptoms including chronic cough, shortness of breath, unexplained weight loss, fatigue, loss of appetite, low-grade fever, etc. The diagnosis is most often made by lung biopsy and bacterial culture.…”

Section: ■ Introductionmentioning

confidence: 99%

“…Lung cancer is the most common cancer with a worldwide incidence of 1.2 million and a mortality of 1.1 million . About 40% of exudative pleural effusions are related to lung cancer − and about 55% are related to pulmonary tuberculosis . Clinically, both conditions showed overlapping symptoms including chronic cough, shortness of breath, unexplained weight loss, fatigue, loss of appetite, low-grade fever, etc.…”

Section: Introductionmentioning

confidence: 99%

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Untargeted Mass Spectrometry-Based Metabolomic Profiling of Pleural Effusions: Fatty Acids as Novel Cancer Biomarkers for Malignant Pleural Effusions

Lam

Law

2014

J. Proteome Res.

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Untargeted mass spectrometry-based metabolomic profiling is a powerful analytical method used for broad-spectrum identification and quantification of metabolites in biofluids in human health and disease states. In this study, we exploit metabolomic profiling for cancer biomarker discovery for diagnosis of malignant pleural effusions. We envisage the result will be clinically useful since currently there are no cancer biomarkers that are accurate enough for the diagnosis of malignant pleural effusions. Metabolomes of 32 malignant pleural effusions from lung cancer patients and 18 benign effusions from patients with pulmonary tuberculosis were analyzed using reversed-phase liquid chromatography tandem mass spectrometry (LC-MS/MS) using AB SCIEX TripleTOF 5600. MS spectra were analyzed using XCMS, PeakView, and LipidView. Metabolome-Wide Association Study (MWAS) was performed by Receiver Operating Characteristic Curve Explorer and Tester (ROCCET). Insignificant markers were filtered out using a metabolome-wide significance level (MWSL) with p-value < 2 × 10(-5) for t test. Only compounds in Human Metabolome Database (HMDB) will be used as cancer biomarkers. ROCCET analysis of ESI positive and negative MS spectra revealed free fatty acid (FFA) 18:1 (oleic acid) had the largest area-under-ROC of 0.96 (95% CI = 0.87-1.00) in malignant pleural effusions. Using a ratio of FFA 18:1-to-ceramide (d18:1/16:0), the area-under-ROC was further increased to 0.99 (95% CI = 0.91-1.00) with sensitivity 93.8% and specificity 100.0%. Using untargeted metabolomic profiling, the diagnostic cancer biomarker with the largest area-under-ROC can be determined objectively. This lipogenic phenotype could be explained by overexpression of fatty acid synthase (FASN) in cancer cells. The diagnostic performance of FFA 18:1-to-ceramide (d18:1/16:0) ratio supports its use for diagnosis of malignant pleural effusions.

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Section: ■ Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Untargeted Mass Spectrometry-Based Metabolomic Profiling of Pleural Effusions: Fatty Acids as Novel Cancer Biomarkers for Malignant Pleural Effusions

Lam

Law

2014

J. Proteome Res.

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“…Mohd Arif Siddiqui study 6 showed parapneumonic effusions of 14.5% and malignant pleural effusions of 11.5% and the results in this regard are similar to our study. Arnab Maji et al 13 in their study had higher percentage of malignant pleural effusions of around 28% in their study of 568 patients of exudative Pleural effusions. Lung malignancies are the commonest cause of malignant pleural effusions in our study and also in Arnab Maji study, 13 Basu A chakrbarty I et al 14 concluded the importance of pleural biopsy and ADA level and found that ADA levels of 70 IU/L are highly suggestive of tubercular aetiology.…”

mentioning

confidence: 81%

“…Arnab Maji et al 13 in their study had higher percentage of malignant pleural effusions of around 28% in their study of 568 patients of exudative Pleural effusions. Lung malignancies are the commonest cause of malignant pleural effusions in our study and also in Arnab Maji study, 13 Basu A chakrbarty I et al 14 concluded the importance of pleural biopsy and ADA level and found that ADA levels of 70 IU/L are highly suggestive of tubercular aetiology. It requires extensive investigations when pleural effusions are found positive for secondary malignancy as a wide number of organs can cause secondary malignancy in the pleura.…”

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confidence: 81%

Study of 200 Cases of Pleural Fluid

Ramakrishna¹,

P²

2016

jebmh

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BACKGROUND We have studied 200 patients of pleural fluid presenting to our tertiary care centre. Presence of cases of pleural fluid is a common presentation both in pulmonary and extrapulmonary diseases. We analysed the patients having both exudates and transudates and studied the results. MATERIALS AND METHODS We selected patients above 20 years of age and classified the patients with pleural fluid as having transudates and exudates. We studied the causes of transudates and exudates. A total of 200 patients are studied in this prospective study. Diagnosis of pleural exudates is made on the basis of Light's criteria, chest x-ray, pleural fluid analysis, CT scan in selected patients, sputum examination, bronchoscopy and bronchial washings. Moribund and non-cooperative patients and HIV positives were excluded from the study. RESULTS Among the 200 patients, 91% have exudates. 9% have transudates by Light's criteria. Tuberculosis is the commonest cause of effusions (64.83%) followed by malignancy (13.73%) and sympneumonic or parapneumonic effusions (9.89%). Pleural effusions occurred predominantly in males. Prevalence of diabetes Mellitus among cases of tuberculous pleural effusions is 13.56%. Tuberculous effusions are predominantly right-sided. CONCLUSION Predominant cases of pleural fluid are exudates. Commonest cause of pleural effusion is Tuberculosis followed by malignancy both pulmonary and extrapulmonary and sym. and parapneumonic effusions. Prevalence of Diabetes among Tuberculous pleural effusion cases is more or less same as in general population. Cough, expectoration fever, chest pain and breathlessness are the common symptoms occurring in three fourths of the patients of tuberculous pleural effusion. Most of the cases of Tuberculous effusion are above 30 years of age. In the diagnosis of tuberculous pleural effusion, Pleural fluid ADA is very important. Pleural fluid cytology, pleural biopsy, bronchoscopy, bronchial washings and sputum examination can aid in diagnosis of aetiology. Lung cancer is the commonest cause of malignant pleural effusions. Other causes of pleural effusion though rare should be considered in selective patients.

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“…Tuberculous pleural effusion (TPE) is the second most common type of extra-pulmonary tuberculosis (TB) (1,2) and is a common cause of pleural effusion in TB-endemic regions (3,4). Moreover, extra-pulmonary involvement tends to increase in frequency with an increasingly compromised immune system (5).…”

Section: Introductionmentioning

confidence: 99%

Different characteristics of tuberculous pleural effusion according to pleural fluid cellular predominance and loculation

et al. 2016

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Background: Tuberculous pleural effusion (TPE) exhibits different characteristics according to pleural fluid cellular predominance or whether the pleural fluid is free-flowing or loculated. However, its categorization based on either of these factors alone may be insufficient to properly reflect the heterogeneous manifestation of TPE. We evaluated the characteristics of the four TPE groups classified according to cellular predominance and whether the fluid is free-flowing or loculated.Methods: A cohort of 375 patients with TPE was retrospectively reviewed. Clinical, radiological, and laboratory findings were compared between neutrophilic and lymphocytic TPE, and between free-flowing and loculated effusion for both neutrophilic and lymphocytic TPE.Results: Lymphocytic TPE and neutrophilic TPE were observed in 336 (90%) and 39 (10%) patients, respectively. Pleural fluid loculation was present in 36% and 31% of the patients in the lymphocytic and neutrophilic groups, respectively. A few parameters of the laboratory findings between neutrophilic and lymphocytic TPE patients showed significant differences. However, these significant differences were prominently observed when comparing free-flowing and loculated subgroups of the respective neutrophilic and lymphocytic groups. Pleural fluid pH, lactate dehydrogenase, and adenosine deaminase levels were significantly different among the four subgroups. The neutrophilic loculated subgroup exhibited the most intense pleural inflammation and the highest mycobacterial yields when compared to the other subgroups.However, the percentage of neutrophils in the pleural fluid was not positively associated with the probability of culture-positive effusion. Conclusions:The heterogeneous manifestation of TPE would be better characterized by using a classification system based on combined pleural fluid cellular predominance and loculation, with the neutrophilic loculated subgroup contributing to most of the clinically significant differences.

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Role of Common Investigations in Aetiological Evaluation of Exudative Pleural Effusions

Abstract: Above mentioned commonly available investigations can ascertain diagnosis in most of the cases in the aetiological evaluation of exudative effusions and they are relatively safe procedures.

Cited by 9 publications

References 16 publications

Untargeted Mass Spectrometry-Based Metabolomic Profiling of Pleural Effusions: Fatty Acids as Novel Cancer Biomarkers for Malignant Pleural Effusions

Untargeted Mass Spectrometry-Based Metabolomic Profiling of Pleural Effusions: Fatty Acids as Novel Cancer Biomarkers for Malignant Pleural Effusions

Study of 200 Cases of Pleural Fluid

Different characteristics of tuberculous pleural effusion according to pleural fluid cellular predominance and loculation

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