Routine Measurement of Pleural Fluid Amylase Is Not Indicated

Branca, Paul; Rodriguez, R. Michael; Rogers, June; Ayo, Dereje S.; Moyers, J. Phillip; Light, Richard W.

doi:10.1001/archinte.161.2.228

Cited by 58 publications

(36 citation statements)

References 18 publications

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“…It is reported that nearly half of the patients with ARPE have also increased level of serum amylase produced by ectopic tumor cells (Salt and Schenker, 1976;Devuyst et al, 1990;Branca et al, 2001;Light, 2007;Hooper et al, 2010). On the other hand PA may accumulate in pleural space due to tumoral obstruction of lymphatics (Branca et al, 2001). Pleural amylase levels were investigated by many studies and some of them reported a significant correlation between PA and lung cancers particularly adenocarcinoma (Foresti et al, 1994;Gupta et al, 2001;Villena et al, 2002;) Villena et al (2002) reported a positive correlation between increased levels of amylase in ARPE and malignancy and the average expectancy of life also decreased by high PA levels.…”

Section: Discussionmentioning

confidence: 99%

Analysis of pleural amylase levels in a chest disease clinic

Türkeli¹,

Atıcı²,

Kayhan³

et al. 2014

jecm

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IntroductionDiagnosis of pleural effusion generally needs a systematic evaluation of the patient. Especially exudative effusions have an extensive differential diagnosis. There are many useful tests that have been recommended for routine evaluation of pleural effusions. Measuring of pleural fluid amylase levels was also recommended in exudative effusions previously (Joseph et al., 1992). Elevated pleural fluid amylase levels are potentially helpful in the diagnosis of pancreatitis, esophageal rupture and some of the malignant diseases (Villena et al., 2002). The history, physical examination, and serologic studies associated with pancreatitis usually suggest this diagnosis without further confirmatory studies. Measurement of pleural amylase lacks the sensitivity to serve as a screening study for malignancy. Therefore, it is difficult to justify the routine measurement of pleural fluid amylase levels except suspicion of pancreatic disease or esophageal rupture (Branca et al., 2001). The purpose of this study was to assess the utility of pleural fluid amylase measurement in the evaluation of pleural effusions. Materials and methods Study population and ethical considerationsPrior to the start of the study, ethical approval was obtained from the ethics committee of Ondokuz Mayıs University with approval number of 2010/96. We enrolled 115 consecutive patients with pleural effusions. They were assessed in our pulmonary disease clinic during the 24-month period from December 2009 through December 2011. All the patients were informed about the study and they gave their consent to this investigation. There were 76 male and 39 female patients. After completion of clinical evaluation, all patients underwent thoracentesis by the guidance of radiology. Pleural effusions were classified into four diagnostic groups as malignant effusion, paramalignant effusion, parapneumonic.

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Section: Discussionmentioning

confidence: 99%

Analysis of pleural amylase levels in a chest disease clinic

Türkeli¹,

Atıcı²,

Kayhan³

et al. 2014

jecm

View full text Add to dashboard Cite

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“…A veces se observan partículas de comida. De todas formas, su determinació n rutinaria no está justificada 43 .…”

Section: Amilasaunclassified

Contribución del análisis del líquido pleural al diagnóstico de los derrames pleurales

2015

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Analysis of pleural fluid can have, on its own, a high diagnostic value. In addition to thoracocentesis, a diagnostic hypothesis based on medical history, physical examination, blood analysis and imaging tests, the diagnostic effectiveness will significantly increase in order to establish a definite or high probable diagnosis in a substantial number of patients. Differentiating transudates from exudates by the classical Light's criteria helps knowing the pathogenic mechanism resulting in pleural effusion, and it is also useful for differential diagnosis purposes. An increased N-terminal pro-brain natriuretic peptide, both in the fluid and in blood, in a due clinical context, is highly suggestive of heart failure. The presence of an increased inflammatory marker, such as C-reactive protein, together with the presence of over 50% of neutrophils is highly suggestive of parapneumonic pleural effusion. If, in these cases, the pH is<7.20, then the likelihood of complicated pleural effusion is high. There remains to be demonstrated the usefulness of other markers to differentiate complicated from uncomplicated effusions. An adenosine deaminase > 45 U/L and>50% lymphocytes is suggestive of tuberculosis. If a malignant effusion is suspected but the cytological result is negative, increased concentrations of some markers in the pleural fluid can yield high specificity values. Increased levels of mesothelin and fibruline-3 are suggestive of mesothelioma. Immunohistochemical studies can be useful to differentiate reactive mesothelial cells, mesothelioma and metastatic adenocarcinoma. An inadequate use of the information provided by the analysis of pleural fluid would results in a high rate of undiagnosed effusions, which is unacceptable in current clinical practice.

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“…In der Literatur wurde die Fistelung ins Mediastinum, nach thorakal, zum Kolon und in die Leber beschrieben [2]. Pankreatikopleurale Fisteln werden insbesondere bei der chronischen Pankreatitis ethyltoxischer Genese beobachtet und entstehen als Folge rupturierter Pseudozysten oder fortschreitender Organnekrosen, insbesondere nach rezidivierenden akuten Schüben [3,4]. Davon differenzialdiagnostisch abgegrenzt werden müssen rezidivierende Pleuraergüsse durch transdiaphragmale Lymphfisteln oder häufig auftretende Pleuraergüsse im Rahmen einer akuten Pankreatitis.…”

Section: Pankreasfisteln Epidemiologieunclassified

“…Eine weitere therapeutische interventionellendoskopische Option stellt die Platzierung einer nasopankreatischen Sonde direkt in den Fistelgang dar [3,4]. …”

Section: Therapieunclassified