Challenges of pleural aspirate cytology: A 5-year review

Abstract

Introduction: Pleural effusion is a common medical condition, and the aspiration of the pleural cavity is a minimally invasive, cheap, and simple technique with the potential to achieve a clinically useful diagnosis. Challenges in the optimization of this investigative modality, however, occur in our everyday practice. Aim: The purpose of this review was to highlight the challenges in the cytopathological evaluation of pleural aspirates in our environment. Materials and Methods: The data regarding pleural fluid (PF) aspirates received for cytopathological evaluation between January 1, 2010, and December 31, 2014, were retrieved from departmental records and analyzed. Results: PF aspirates from 69 patients, with a male–female ratio of 1:1.03, were studied. The modal age group was 30–39 years, and the mean age was 45 ± 21.40 years. Of 69 smears, 40.6% were categorized as unsatisfactory/nondiagnostic, 44.9% were in the “negative for malignancy/normal/benign” category, 1.4% were in the “atypical-favor reactive” category, 4.3% were “atypical-suspicious for malignancy,” and 8.7% were “positive for malignancy.” The male–female ratio of patients with malignant pleural effusions was 1:5, and 66.7% of malignant smears were from persons above 50 years. Thirty-nine percent of total smears wear “inflammatory.” The large number of unsatisfactory smears is a major challenge. Conclusion: Pleural aspirate cytology can be a useful investigative tool with the potential for definitive diagnosis or other useful information for clinical decision-making. To maximize its diagnostic potential in our environment, however, the current challenges must be overcome.