The Value of Cytology in the Evaluation of Malignant Pericardial Effusions: A Systematic Review.

Ranim Shartouni,Ilias P Nikas,Maryam Mahmoodi,Roy Shartouni

doi:10.3390/diagnostics12020367

Ranim Shartouni, Ilias P Nikas + Show 2 more

Open Access

https://doi.org/10.3390/diagnostics12020367

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Journal: Diagnostics	Publication Date: Feb 1, 2022
Citations: 7	License type: CC BY 4.0

Affiliation: European University Cyprus

Abstract

Pericardial effusions can be caused by diverse etiologies, including heart-related conditions, kidney failure, trauma, infections, autoimmune diseases, and cancer. This systematic review aimed to assess the role of cytology in identifying the most prevalent cancers related to malignant pericardial effusions (MPEs), the ability of cytology, compared to histology, to detect cancer while evaluating pericardial effusions, and the prognostic impact of MPEs. Four electronic databases were investigated using a predefined algorithm, and specific inclusion and exclusion criteria. We found that the most prevalent primaries associated with MPEs were lung (especially NSCLCs), breast, hematolymphoid, and gastrointestinal cancers. MPEs tended to be hemorrhagic rather than serous or serosanguinous and to occupy larger volumes compared to non-neoplastic effusions. In addition, cytology was shown to exhibit an enhanced ability to detect cancer compared to biopsy in most of the included studies. Lastly, the presence of an MPE was associated with poor prognosis, while survival depended on the specific cancer type detected. Particularly, prognosis was found to be worse when MPEs were caused by lung or gastric cancer, rather than breast or hematolymphoid malignancies. In conclusion, evidence suggests that cytologic evaluation has a significant diagnostic and prognostic impact in patients with MPEs.

Highlights

A pericardial effusion, which is formed by the accumulation of excessive fluid within the pericardial cavity, is a prevalent manifestation clinicians face [1]
Cancerassociated pericardial effusions might be either free from malignancy—for instance, when induced by chemotherapy or radiotherapy—or show evidence of cancer cells; the latter are most often derived from a metastasis rather than a primary lesion
In a cohort composed of cancer-associated pericardial effusions, the presence of suspicious/malignant cytology was linked with shorter median survival compared to normal cytology (7.3 vs. 29.7 weeks; p = 0.02)

Summary

Introduction

A pericardial effusion, which is formed by the accumulation of excessive fluid within the pericardial cavity, is a prevalent manifestation clinicians face [1]. It can be caused by diverse etiologies, such as heart-related conditions (e.g., myocardial infarction or cardiac surgery), kidney failure, trauma, infections, autoimmune diseases, and cancer [1,2,3]. Cytology is one of the diagnostic modalities used to identify the cause of a pericardial effusion, to detect whether cancer cells are present within the fluid [3,4]. The International System for Reporting Serous Fluid Cytology (ISRSFC) has been reported with the goal to improve diagnosis, standardize reporting, and facilitate communication among physicians [8]

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