Abstract
BackgroundThe diagnostic value of clinical and laboratory features to differentiate between malignant pleural effusion (MPE) and benign pleural effusion (BPE) has not yet been established.ObjectivesThe present study aimed to develop and validate the diagnostic accuracy of a scoring system based on a nomogram to distinguish MPE from BPE.MethodsA total of 1,239 eligible patients with PE were recruited in this study and randomly divided into a training set and an internal validation set at a ratio of 7:3. Logistic regression analysis was performed in the training set, and a nomogram was developed using selected predictors. The diagnostic accuracy of an innovative scoring system based on the nomogram was established and validated in the training, internal validation, and external validation sets (n = 217). The discriminatory power and the calibration and clinical values of the prediction model were evaluated.ResultsSeven variables [effusion carcinoembryonic antigen (CEA), effusion adenosine deaminase (ADA), erythrocyte sedimentation rate (ESR), PE/serum CEA ratio (CEA ratio), effusion carbohydrate antigen 19-9 (CA19-9), effusion cytokeratin 19 fragment (CYFRA 21-1), and serum lactate dehydrogenase (LDH)/effusion ADA ratio (cancer ratio, CR)] were validated and used to develop a nomogram. The prediction model showed both good discrimination and calibration capabilities for all sets. A scoring system was established based on the nomogram scores to distinguish MPE from BPE. The scoring system showed favorable diagnostic performance in the training set [area under the curve (AUC) = 0.955, 95% confidence interval (CI) = 0.942–0.968], the internal validation set (AUC = 0.952, 95% CI = 0.932–0.973), and the external validation set (AUC = 0.973, 95% CI = 0.956–0.990). In addition, the scoring system achieved satisfactory discriminative abilities at separating lung cancer-associated MPE from tuberculous pleurisy effusion (TPE) in the combined training and validation sets.ConclusionsThe present study developed and validated a scoring system based on seven parameters. The scoring system exhibited a reliable diagnostic performance in distinguishing MPE from BPE and might guide clinical decision-making.
Highlights
Pleural effusion (PE) is a common clinical problem resulting from increased fluid in the pleural cavity [1, 2]
The inclusion criteria were as follows: a) PE was diagnosed after ultrasonography, chest CT, or X-ray and b) patients underwent diagnosis for malignant pleural effusion (MPE) or benign pleural effusion (BPE) by cytology and/or thoracentesis and/ or pleural biopsy and follow-up
The requirement for written informed consent was waived based on the retrospective nature
Summary
Pleural effusion (PE) is a common clinical problem resulting from increased fluid in the pleural cavity [1, 2]. The various etiologies of PE can be divided into benign pleural effusion (BPE) and malignant pleural effusion (MPE) [3]. The presence of MPE indicates systemic cancer dissemination and a reduction of life expectancy and quality in patients [6]. The median survival in patients with MPE is 3–12 months [7, 8]. An accurate and noninvasive method to diagnose patients with MPE is crucial for therapeutic decisions. The diagnostic value of clinical and laboratory features to differentiate between malignant pleural effusion (MPE) and benign pleural effusion (BPE) has not yet been established
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