Evaluation of Exudative Pleural Effusions: A Multicenter, Prospective, Observational Study.
Benign pleural effusion
Cytological diagnostic sensitivity
Exudative pleural effusion
Image-guided pleural biopsy
Malignant pleural effusion
Journal
Lung
ISSN: 1432-1750
Titre abrégé: Lung
Pays: United States
ID NLM: 7701875
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
received:
26
06
2022
accepted:
21
09
2022
pubmed:
30
9
2022
medline:
23
11
2022
entrez:
29
9
2022
Statut:
ppublish
Résumé
The aim of this study is to determine the diagnostic performances of pleural procedures in undiagnosed exudative pleural effusions and to evaluate factors suggestive of benign or malignant pleural effusions in tertiary care centers. This was a multicenter prospective observational study conducted between January 1 and December 31, 2018. A total of 777 patients with undiagnosed exudative pleural effusion after the initial work-up were evaluated. The results of diagnostic procedures and the patients' diagnoses were prospectively recorded. Sensitivity, specificity, and accuracy estimates with 95% confidence intervals were used to examine the performance of pleural procedures to detect malignancy. The mean age ± SD of the 777 patients was 62.0 ± 16.0 years, and 68.3% of them were male. The most common cause was malignancy (38.3%). Lung cancer was the leading cause of malignant pleural effusions (20.2%). The diagnostic sensitivity and accuracy of cytology were 59.5% and 84.3%, respectively. The diagnostic sensitivity of image-guided pleural biopsy was 86.4%. The addition of image-guided pleural biopsy to cytology increased diagnostic sensitivity to more than 90%. Thoracoscopic biopsy provided the highest diagnostic sensitivity (94.3%). The highest diagnostic sensitivity of cytology was determined in metastatic pleural effusion from breast cancer (86.7%). The diagnostic performance increases considerably when cytology is combined with image-guided pleural biopsy in malignant pleural effusions. However, to avoid unnecessary interventions and complications, the development of criteria to distinguish patients with benign pleural effusions is as important as the identification of patients with malignant pleural effusions.
Identifiants
pubmed: 36173482
doi: 10.1007/s00408-022-00573-8
pii: 10.1007/s00408-022-00573-8
doi:
Types de publication
Observational Study
Multicenter Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
807-815Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Light RW (2011) Pleural effusions. Med Clin 95:1055–1070. https://doi.org/10.1016/j.mcna.2011.08.005
doi: 10.1016/j.mcna.2011.08.005
Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr (1972) Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 77:507–13. https://doi.org/10.7326/0003-4819-77-4-507
doi: 10.7326/0003-4819-77-4-507
pubmed: 4642731
Arnold DT, De Fonseka D, Perry S, Morley A, Harvey JE, Medford A, Brett M, Maskell NA (2018) Investigating unilateral pleural effusions: the role of cytology. Eur Respir J 52:1801254. https://doi.org/10.1183/13993003.01254-2018
doi: 10.1183/13993003.01254-2018
pubmed: 30262573
Metintas M, Ak G, Dundar E, Yildirim H, Ozkan R, Kurt E, Erginel S, Alatas F, Metintas S (2010) Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial. Chest 137:1362–1368. https://doi.org/10.1378/chest.09-0884
doi: 10.1378/chest.09-0884
pubmed: 20154079
Porcel JM, Azzopardi M, Koegelenberg CF, Maldonado F, Rahman NM, Lee YC (2015) The diagnosis of pleural effusions. Expert Rev Respir Med 9:801–815. https://doi.org/10.1586/17476348.2015.1098535
doi: 10.1586/17476348.2015.1098535
pubmed: 26449328
Metintas M, Ak G, Cadirci O, Yildirim H, Dundar E, Metintas S (2012) Outcome of patients diagnosed with fibrinous pleuritis after medical thoracoscopy. Respir Med 106:1177–1183. https://doi.org/10.1016/j.rmed.2012.04.009
doi: 10.1016/j.rmed.2012.04.009
pubmed: 22608353
Janssen J, Maldonado F, Metintas M (2018) What is the significance of non-specific pleuritis? A trick question. Clin Respir J 12:2407–2410. https://doi.org/10.1111/crj.12940
doi: 10.1111/crj.12940
pubmed: 30004629
Davies HE, Nicholson JE, Rahman NM, Wilkinson EM, Davies RJ, Lee YC (2010) Outcome of patients with nonspecific pleuritis/fibrosis on thoracoscopic pleural biopsies. Eur J Cardiothorac Surg 38:472–477. https://doi.org/10.1016/j.ejcts.2010.01.057
doi: 10.1016/j.ejcts.2010.01.057
pubmed: 20219385
Metintas M, Ak G, Metintas S, Yildirim H, Dündar E, Rahman N (2019) Prospective study of the utility of computed tomography triage of pleural biopsy strategies in patients with pleural diseases. J Bronchology Interv Pulmonol 26:210–218. https://doi.org/10.1097/LBR.0000000000000559
doi: 10.1097/LBR.0000000000000559
pubmed: 31211722
Metintas M, Turkish Respiratory Society and Turkish Thoracic Society Pleural Guideline Group (2016) Göğüs Hastalıkları Uzmanları İçin Plevra Hastalıkları Tanı ve Tedavi Rehberi. Ankara, 1–41 (in Turkish)
Hooper C, Lee YC, Maskell N; BTS Pleural Guideline Group (2010) Investigation of a unilateral pleural effusion in adults: British thoracic society pleural disease guideline 2010. Thorax 65(Suppl 2):ii4-17. https://doi.org/10.1136/thx.2010.136978
doi: 10.1136/thx.2010.136978
Light R (2013) Pleural disease. Lippincott Williams & Wilkins, Philadelphia
Porcel JM, Esquerda A, Vives M, Bielsa S (2014) Etiology of pleural effusions: analysis of more than 3000 consecutive thoracenteses. Arch Bronconeumol 50:161–165. https://doi.org/10.1016/j.arbres.2013.11.007
doi: 10.1016/j.arbres.2013.11.007
pubmed: 24360987
Park JE, Do YW, Lee DH, Lee SY, Lim JK, Choi SH, Seo HW, Yoo SS, Lee SY, Cha SI, Park JY, Lee J, Kim CH (2020) Idiopathic pleural effusions: characteristics and discrimination from cytology-negative malignant pleural effusions. Am J Med Sci 360:236–242. https://doi.org/10.1016/j.amjms.2020.04.020
doi: 10.1016/j.amjms.2020.04.020
pubmed: 32423747
Zhang Y, Luo G, Etxeberria J, Hao Y (2021) Global patterns and trends in lung cancer incidence: a population-based study. J Thorac Oncol 16:933–944. https://doi.org/10.1016/j.jtho.2021.01.1626
doi: 10.1016/j.jtho.2021.01.1626
pubmed: 33607309
Metintaş S, Batırel HF, Bayram H, Yılmaz Ü, Karadağ M, Ak G, Metintaş M (2017) Turkey national mesothelioma surveillance and environmental asbestos exposure control program. Int J Environ Res Public Health 14:1293. https://doi.org/10.3390/ijerph14111293
doi: 10.3390/ijerph14111293
pmcid: 5707932
Romero-Candeira S, Hernández L, Romero-Brufao S, Orts D, Fernández C, Martín C (2002) Is it meaningful to use biochemical parameters to discriminate between transudative and exudative pleural effusions? Chest 122:1524–1529. https://doi.org/10.1378/chest.122.5.1524
doi: 10.1378/chest.122.5.1524
pubmed: 12426248
Romero-Candeira S, Fernández C, Martín C, Sánchez-Paya J, Hernández L (2001) Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart failure. Am J Med 110:681–686. https://doi.org/10.1016/s0002-9343(01)00726-4
doi: 10.1016/s0002-9343(01)00726-4
pubmed: 11403751
Walker SP, Morley AJ, Stadon L, De Fonseka D, Arnold DT, Medford ARL, Maskell NA (2017) Nonmalignant pleural effusions: a prospective study of 356 consecutive unselected patients. Chest 151:1099–1105. https://doi.org/10.1016/j.chest.2016.12.014
doi: 10.1016/j.chest.2016.12.014
pubmed: 28025056
Abd Own S, Höijer J, Hillerdahl G, Dobra K, Hjerpe A (2021) Effusion cytology of malignant mesothelioma enables earlier diagnosis and recognizes patients with better prognosis. Diagn Cytopathol 49:606–614. https://doi.org/10.1002/dc.24395
doi: 10.1002/dc.24395
pubmed: 32049443