Abstract
BackgroundWe evaluated malignancy according to the characteristics of pericardial fluid in symptomatic Japanese patients undergoing pericardiocentesis and computed tomography (CT).MethodsThis was a retrospective, single-center, observational study of 125 symptomatic patients undergoing pericardiocentesis. The patients were classified into two groups: a malignancy group and a non-malignancy group, according to the primary disease and cytology of the pericardial effusion (PE). We compared the pericardial fluid sample and CT measurements between both groups.ResultsAll patients were diagnosed as having exudative PE by Light’s criteria. PE with malignant cells was demonstrated in 76.8% of the malignancy group patients. Pericardial to serum lactate dehydrogenase (LDH) ratio > 0.6, as one of Light’s criteria, was associated with malignancy (p = 0.017). Lower serum brain natriuretic peptide (BNP) concentration was also associated with malignancy (BNP: 126.9 ± 89.8 pg/ml vs 409.2 ± 97.7 pg/ml, malignancy vs non-malignancy groups, respectively; p = 0.037). A significant difference was observed in pericardial fluid glucose level between the malignancy and non-malignancy groups (pericardial fluid glucose: 78.24 ± 48.29 mg/dl vs 98.41 ± 44.85, respectively; p = 0.048). Moreover, CT attenuation values (Hounsfield units (HU)) tended to be higher in the malignancy group vs the non-malignancy group (22.7 [interquartile range (IQR), 17.4–26.0] vs 17.4 [IQR, 13.7–26.4], respectively; p = 0.08). The sensitivity and specificity of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 40.9% and 89.6%, respectively, in the malignancy group. The positive- and negative predictive values of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 85.7% and 50.0%, respectively, in the malignancy group. Pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were cutoff values associated with malignancy (p = 0.012).ConclusionsLower pericardial fluid glucose level with higher CT attenuation values may suggest malignancy-related PE.
Highlights
We evaluated malignancy according to the characteristics of pericardial fluid in symptomatic Japanese patients undergoing pericardiocentesis and computed tomography (CT)
Blood samples (Table 3) No significant differences in serum C-reactive protein (CRP), total protein, lactate dehydrogenase (LDH), albumin, glucose, and Hb were observed between the malignancy and non-malignancy groups
Serum brain natriuretic peptide (BNP) levels were significantly lower in patients with vs without malignancy (126.89 ± 183.35 pg/ml vs 409.18 ± 868.67 pg/ml, respectively; p = 0.037)
Summary
We evaluated malignancy according to the characteristics of pericardial fluid in symptomatic Japanese patients undergoing pericardiocentesis and computed tomography (CT). In patients with PE, the prevalence of malignancy or infection ranges from 15 to 50% [2, 3], and malignant PE can be diagnosed by cytology. In addition to imaging and pericardial fluid analysis, the clinical course of the underlying disease can contribute to the diagnosis of malignancy-related PE. The relationship between malignancy-related PE and non-malignant PE evaluated using computed tomography (CT) to analyze the pericardial fluid is unknown. We examined malignancy according to the characteristics of the pericardial fluid and CT measurements in patients with symptoms associated with PE undergoing pericardiocentesis
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