Volume of Pleural Fluid Required for Diagnosis of Pleural Malignancy

Sallach, Susan M.; Sallach, John A.; Vásquez, E Martha; Schultz, Lonni; Kvale, Paul A.

doi:10.1378/chest.122.6.1913

Cited by 68 publications

(46 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…And these results agree with Sallach et al [18] who reported that the transudative effusion with low WBC count <500 cells/cmm, and Light [19]; who reported that transudative effusion with small count of WBC.…”

Section: Discussionsupporting

confidence: 91%

Diagnostic significance of pleural fluid pH and pCO2

Sobhey

Naglaa

2015

Egyptian Journal of Chest Diseases and Tuberculosis

View full text Add to dashboard Cite

The diagnosis of pleural effusion is still difficult. The presence of pleural effusion can be confirmed by radiological studies including simple chest radiography, ultrasonography, or computed tomography. Identifying the causes of pleural effusions by pleural fluid analysis is essential.Aim of this work: The aim of this work is to assess the role of pleural fluid pH and pCO 2 in differentiating the etiologies of pleural effusion and to study the correlation between pleural fluid pH and pCO 2 and cellular content of the effusion.Results: We conducted this study on 50 patients with pleural effusions of different causes. The patients were classified into 5 groups according to the cause. For all the patients, measurement of pleural pH, pCO 2 , pO 2 , HCO 3 , protein, LDH, glucose and WBC was done. We observed lowest pH in complicated parapneumonic effusion (empyema) 6.80 ± 0.15 and highest pH was observed in transudative effusion 7.47 ± 0.07. Tuberculous effusion has pH lower than pH of malignant effusion 7.17 ± 0.017 and 7.39 ± 0.08, respectively. Post pleurodesis malignant effusion has pH lower than pH of malignant effusion 7.28 ± 0.17 and 7.39 ± 0.08, respectively. There is a strong inverse correlation between pH and pCO 2 , WBC, LDH and protein (r = À0.813 and p < 0.001), (r = À0.796 and p, 0.001), (r = À0.829 and p, 0.001) and (r = À.837 and p, 0.001), respectively. While there is a weak correlation between pH and glucose of pleural fluid (r = 0.249 and p = 0.066). The highest increase of PNL numbers was in empyema (20169 ± 8094.8 cells/cc). The highest increase of lymphocytes was in malignant effusions (4285.00 ± 2948.20 cells/cc) and tuberculous effusion (3977.7 ± 3169 cells/cc).

show abstract

Section: Discussionsupporting

confidence: 91%

Diagnostic significance of pleural fluid pH and pCO2

Sobhey

Naglaa

2015

Egyptian Journal of Chest Diseases and Tuberculosis

View full text Add to dashboard Cite

show abstract

“…Pleural fluid cytological analysis is critical in any patient who had suspected malignancy or an exudative effusion of unknown origin [27]. Several factors influence the diagnostic potential of pleural fluid cytology.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic yield of medical thoracoscopy in diagnosis of exudative pleural effusion: One year prospective study

Mohamed

Shaban

2014

Egyptian Journal of Chest Diseases and Tuberculosis

View full text Add to dashboard Cite

Background: Differential diagnosis of pleural disease is often a lengthy process fraught with pitfalls. Contrary to thoracocentesis and closed pleural biopsy, thoracoscopy permits biopsy with direct visualization. Medical thoracoscopy increases the diagnostic yield in patients with pleural disease when thoracocentesis and closed pleural biopsy are non diagnostic.Aim of the work: This study investigated diagnostic yield of medical thoracoscopy for undiagnosed exudative pleural effusions over one year period.Patient and Methods: This study included 117 patients with undiagnosed exudative pleural effusions. All patients were subjected to written informed consent, full history taking, clinical examination, plain chest X-ray, CT chest and tuberculin skin test. Diagnostic pleural aspiration was done with pleural fluid chemical and cytological analysis. Patients with unhelpful pleural fluid analysis underwent medical thoracoscopy.Results: Regarding thoracoscopic pleural biopsy histopathology, out of 117 patients, 55 were diagnosed as malignant pleural mesothelioma, 26 diagnosed as metastatic adenocarcinoma, 1 diagnosed as spindle cell carcinoma, 5 diagnosed as lymphoma, 5 diagnosed as tuberculosis, 1 diagnosed

show abstract

“…The diagnostic accuracy of pleural fluid cytology for a malignant effusion ranges from 40% to 87%, which is higher than that of pleural biopsy. [12]…”

Section: Discussionmentioning

confidence: 99%

“…The gold standard to diagnose malignant pleural effusion is to find malignant cells on cytological examination of pleural fluid or histopathology of pleural biopsy. Cytological analysis has sensitivity from 40% to 87% for malignant pleural effusion,[123] however, the optimal volume of fluid to be sent for cytological analysis is unclear, and only a few studies have addressed this issue. [4567] In an attempt to address this question, we started to divide pleural fluid into three different volumes for cytological examination.…”

Section: Introductionmentioning

confidence: 99%

The minimum volume of pleural fluid required to diagnose malignant pleural effusion: A retrospective study

et al. 2017

View full text Add to dashboard Cite

Background:Pleural fluid cytology is a quick and accurate method to diagnose malignant pleural effusions. The optimal volume of fluid for cytological analysis has not yet been identified, and clinical recommendation based on some published clinical experiences has been to send large volumes of fluid for cytological analysis. A quality improvement initiative at our institution was conducted to determine the volume of fluid sufficient for a diagnosis of malignant pleural effusion.Materials and Methods:The study was approved by the Institutional Review Board. All pleural fluid specimens that were divided into three volumes (25 mL, 50 mL, and 150 mL) and sent for cytological examination were reviewed.Results:A total of 74 samples from 60 individual patients were evaluable. Thirty-six patients (60%) had a previous diagnosis of malignancy. Of the 74 specimens, 26 (35.1%) were positive for malignancy. The detection rate for malignant pleural effusion by cytology for 25 mL, 50 mL, and 150 mL were 88.5%, 96.2%, and 100.0%, respectively (P = 0.16). Two specimens that were negative in the 25 mL samples turned out to be positive in the 50 mL and 150 mL samples. One specimen was negative in the 25 mL and 50 mL samples but positive in the 150 mL sample.Conclusions:Our study did not show any statistically significant difference in the detection of malignant effusion in the 25 mL, 50 mL, and 150 mL group.

show abstract

Volume of Pleural Fluid Required for Diagnosis of Pleural Malignancy

Cited by 68 publications

References 13 publications

Diagnostic significance of pleural fluid pH and pCO2

Diagnostic significance of pleural fluid pH and pCO2

Diagnostic yield of medical thoracoscopy in diagnosis of exudative pleural effusion: One year prospective study

The minimum volume of pleural fluid required to diagnose malignant pleural effusion: A retrospective study

Contact Info

Product

Resources

About