The Significance of a Cytologically Negative Pleural Effusion in Bronchogenic Carcinoma

Non–Small Cell Lung Cancer

“…However, all pleural effusions, despite whether they are malignant, are associated with unresectable disease in 95% of cases. 256 In patients with effusions that are positive for malignancy, the tumor is treated as M1a with local therapy (e.g., ambulatory small catheter drainage, pleurodesis, and pericardial window) in addition to treatment as for stage IV disease (see page 751).…”

Management of malignant pleural effusions

“…These accompanying paramalignant effusions are due to postobstructive pneumonia or atelectasis, venous obstruction by tumour compression, or lymphatic obstruction by mediastinal lymph nodes, and are not associated with direct pleural involvement. Such patients are few in number, but if pleural cytology is negative, the clinician should explore additional diagnostic avenues, including CT, pleural biopsy, medical thoracoscopy, or surgical procedures (VATS/open biopsy) [170].…”

Pleural diseases related to metastatic malignancies

“…A pleural effusion in the setting of lung cancer usually excludes operability; however, approximately 5% of these patients have a paramalignant effusion or effusion from another cause, and may be operable and curable [5]. Thus, it is essential to establish the cause of the pleural effusion before deciding that the patient is no longer a candidate for curative surgery.…”

“…In association with interstitial disease malignancy to invade the pleura and produce malignant and paramalignant effusions (table 2) [2,5,6]. Carcinoma of the breast is second in incidence and, in some series, exceeds lung cancer [7].…”