Cytologic Examination Of Pleural Fluid Research Articles

Evaluation of pleural ?uid cytology for the diagnosis of pleural effusion: A retrospective study

Cytological examination of pleural fluid has good specificity for the diagnosis of malignant pleural effusion (MPE). (1). To study the incidence of non-neoplastic and neoplastic effusions; (2). To study most common cause of neoplastic effusions.This study is an Observational retrospective study that was conducted from April 2021 to October 2022 (1.5 years). This study was conducted in the Cytology section, Pathology Department, of a tertiary care centre, Gujarat, India. A total of 248 pleural fluid samples were studied among them 186 were benign effusions, 48 were malignant effusions, 10 cases were unsatisfactory for evaluation and 4 cases were suspicious for malignancy.A descriptive study was performed to know the incidence of benign and malignant effusion in the pleural fluid sample. Pneumonia was the most common clinical diagnosis followed by tuberculosis and malignancy. Lung was the most common primary site for pleural effusion. In females, ovarian carcinoma was the primary aetiology followed by breast carcinoma. Cytodiagnosis of pleural fluid represents the cell population from a much larger representative area than obtained from the needle biopsy.

Cell-free DNA methylation analysis as a marker of malignancy in pleural fluid

Diagnosis of malignant pleural effusion (MPE) is made by cytological examination of pleural fluid or histological examination of pleural tissue from biopsy. Unfortunately, detection of malignancy using cytology has an overall sensitivity of 50%, and is dependent upon tumor load, volume of fluid assessed, and cytopathologist experience. The diagnostic yield of pleural fluid cytology is also compromised by low abundance of tumor cells or when morphology is obscured by inflammation or reactive mesothelial cells. A reliable molecular marker that may complement fluid cytology for the diagnosis of malignant pleural effusion is needed. The purpose of this study was to establish a molecular diagnostic approach based on pleural effusion cell-free DNA methylation analysis for the differential diagnosis of malignant pleural effusion and benign pleural effusion. This was a blind, prospective case–control biomarker study. We recruited 104 patients with pleural effusion for the study. We collected pleural fluid from patients with: MPE (n = 48), indeterminate pleural effusion in subjects with known malignancy or IPE (n = 28), and benign PE (n = 28), and performed the Sentinel-MPE liquid biopsy assay. The methylation level of Sentinel-MPE was markedly higher in the MPE samples compared to BPE control samples (p < 0.0001) and the same tendency was observed relative to IPE (p = 0.004). We also noted that the methylation signal was significantly higher in IPE relative to BPE (p < 0.001). We also assessed the diagnostic efficiency of the Sentinel-MPE test by performing receiver operating characteristic analysis (ROC). For the ROC analysis we combined the malignant and indeterminate pleural effusion groups (n = 76) and compared against the benign group (n = 28). The detection sensitivity and specificity of the Sentinel-MPE test was high (AUC = 0.912). The Sentinel-MPE appears to have better performance characteristics than cytology analysis. However, combining Sentinel-MPE with cytology analysis could be an even more effective approach for the diagnosis of MPE. The Sentinel-MPE test can discriminate between BPE and MPE. The Sentinel-MPE liquid biopsy test can detect aberrant DNA in several different tumor types. The Sentinel-MPE test can be a complementary tool to cytology in the diagnosis of MPE.

Osimertinib as First-Line Therapy of Patients with Lung Adenocarcinoma EGFR TKI Mutation from Pleural Fluid Samples: A Case Report

Introduction: Lung cancer is still a major contributor to cancer mortality worldwide. More than 80–85% of cases are constituted by Non-Small Cell Lung Cancer (NSCLC), consisting of approximately 40% adenocarcinomas. The prevalence of T790M mutation also accounts for 30%–50% of resistance to first- and second-generation tyrosine kinase inhibitors (TKI) after 9-12 months of therapy. To overcome this health condition, osimertinib has emerged as a first-line target therapy for lung adenocarcinoma with Epidermal Growth Factor Receptor (EGFR) mutation. Therefore, this study aimed to determine the effectiveness of osimertinib administration as first-line therapy in adenocarcinoma patients with EGFR TKI mutation. Case Presentation: This study presented a case of 60-year-old woman with shortness of breath and cough accompanied by weight loss ± 10 kg in 3 months. Contrast chest MSCT (multislice computed tomography) scan showed a mass in the right lung accompanied by pleural and pericardial effusion. The results of the cytological examination of pleural fluid found a picture of adenocarcinoma. Furthermore, the diagnosis was continued by molecular examination of pleural fluid, and the results of the EGFR Exon 19 mutation were obtained. Based on the results of physical examination and several laboratory tests, a diagnosis of right pleural effusion and EGFR mutation lung adenocarcinoma was established.Conclusions: In this case, there was a clinical improvement after 8 months of osimertinib administration, along with enhancement in the control CT-SCAN. Osimertinib also showed the potential to extend progression-free survival by approximately 18.9 months compared to other generations of tyrosine kinase inhibitor therapy. This result was supported by the improvement of the clinical and performance status of patients in this case during osimertinib administration.

Echogenic swirling pattern, carcinoembryonic antigen, and lactate dehydrogenase in the diagnosis of malignant pleural effusion

The echogenic swirling pattern has a role in predicting malignant pleural effusion (MPE). However, its predictive ability is suboptimal, and its clinical utility remains to be defined. The aim of this study was to assess the diagnostic potential of the echogenic swirling pattern combined with pleural carcinoembryonic antigen (CEA) and routine laboratory tests of pleural effusion in MPE. The 80 consecutive patients with underlying malignancy and pleural effusions were recruited. All patients underwent one diagnostic thoracentesis with a cytologic examination of pleural fluid. Our study showed that the sensitivity of echogenic swirling patterns in MPE diagnosis was 67.7%, specificity was 72.2%, positive predictive value (PPV) was 89.4%, and negative predictive value (NPV) was 39.4%. Both CEA and lactate dehydrogenase (LDH) had acceptable sensitivity (71.0% and 60.7%) and specificity (72.2% and 77.8%). Combining the echogenic swirling pattern, pleural CEA, and pleural LDH, the highest sensitivity (95.2%) with a good PPV (86.8) was reached. In this clinical study, we found that combining the echogenic swirling pattern, pleural CEA, and pleural LDH had a higher sensitivity and a high positive predictive value for the diagnosis of MPE. This combination is a potentially suitable method for MPE screening in cancer patients with pleural effusions.

Histomorphological Spectrum of Pleural Biopsy Specimen of Exudative Pleural Effusion in a Tertiary Care Hospital in Bangladesh

Background: The commonest manifestation of pleural pathology is pleural effusion. Most of the time, in spite of routine biochemical and cytological examination of pleural fluid we can’t evaluate the etiology of pleural effusion. Aim: Aim of present study was to make an etiological diagnosis of exudative pleural effusion by pleural biopsy and histopathological examination. Study design and setting: Fifty consecutive patients of pleural effusion were selected from the outpatient and indoor department of a tertiary medical college hospital in Sylhet. It was a prospective and observational study. It was conducted over a period of one and a halfyears. Material and method: In all the cases, cytological examination of pleural fluid (for malignant cell) and pleural biopsy by Abram’s needle were done. Subsequently, histopathological diagnoses were made to determine the etiology of effusion. Results: Out of 50 subjects, males outnumbered females, Age is ranged between 19 and 85 years. According to the histopathological examination of the submitted pleural biopsy specimen, granulomatous inflammation is the most common etiology (40%) followed by chronic inflammation of non-specific origin (38%) and malignancy (22%). Conclusion: This study represents the result of the experience acquired over one and half years in the histopathological interpretation of pleural biopsies and its correlation with cytology of the pleural fluid. Pleural biopsy is a useful, minimally invasive procedure with no or little complication and has more sensitivity and specificity than pleural fluid cytology smears.

Incidence of Mesothelioma At Imbaba Chest Hospital From 2013 To 2016

Abstract Background Malignant pleural mesothelioma (MPM) is a rare but aggressive and often fatal malignancy. Most patients present with advanced disease, and the median overall survival is approximately one year. Objective To review the cases of malignant mesothelioma admitted to Imbaba Chest Hospital in the period between 2013 and 2016. Subjects and Methods The current study spotted the light over the malignant mesothelioma from epidemiological view, as a retrospective cohort study, conducted on all cases of malignant mesothelioma that were diagnosed at Embaba Chest Hospital in the period between 2013 until 2016 to explore the incidence of that disease and its characteristic features. The medical records of patients had been revised for the demographic criteria of patients, which included; age, sex, smoking status, residence and occupation, clinical presentation of cases, radiological findings, cytological examination of pleural fluid, pleural biopsy either thoracoscopic or open, and finally, histopathological diagnosis. Results The prevalence of mesothelioma across years of the study was 1.5% (60 out of 4000cases) with increasing annual incidence; 1.7, 2 and 2.3% respectively. The mean age of mesothelioma patients was 57.96 years, most of them above 40 years (91.67%) and more than half of them were males (55%). In spite of decreasing percentage of male with mesothelioma within the study time (2014-2016), which was accompanied with increasing the percentage of female patients, it did not reach statistical significance. Conclusion The overall incidence of malignant mesothelioma was 1.5% with increasing annual incidence from 1.7% up to 2.3%. The male gender was the more presentable one with gradual growing of female percent. The urban area was more affected than the rural one, specially the area near industries. Non-exposed persons (unemployed industrial workers) showed higher frequency of MM. Right-sided MM was more common than Left one, beside that the epithelial form of MM was the dominant histological pattern.

Metastatic Mucoepidermoid Carcinoma to the Pleura: An Unusual Presentation

Abstract Casestudy Mucoepidermoid carcinoma is the most common malignant tumor arising in salivary glands. Predictors of poor prognosis include high-grade tumors, positive surgical margins, lymph node metastasis, or distant metastasis. The most common sites for distant metastasis include skin, lung, liver, and bone. We herein present a case of salivary gland mucoepidermoid carcinoma with pleural involvement, which is an infrequent site for metastasis. A 64-year-old female presented with worsening dyspnea and cough, which showed no improvement with antibiotics. Imaging showed a right lung nodule measuring 1.2 cm along with bilateral pleural effusion and pleural based nodularities. The dominant nodules in right and left chest measured 5.8 cm and 4.8 cm in greatest dimension, respectively. The findings were suspicious for metastatic disease. Cytological examination of pleural fluid showed reactive mesothelial cells and inflammatory cells. Subsequent biopsy of the right pleural nodule showed sheets of tumor cells with abundant eosinophilic cytoplasm and few scattered clear cells. Mucocytes were absent. The tumor cells were positive for p40 and negative for TTF-1 by immunohistochemistry. A review of patient’s medical history was significant for high-grade salivary gland mucoepidermoid carcinoma, which was resected and radiated six years prior. A comparison of both lesions showed similar morphologic features. Mucicarmine stain was positive in resection specimen but negative in pleural biopsy, confirming the absence of mucocytes. Molecular studies on both specimens showed positivity for fusion of CRTC1 (19p13) and MAML2 (11q21) loci. The overall findings were consistent with metastatic mucoepidermoid carcinoma to pleura. Conclusion Pleura is an uncommon site for metastasis from primary salivary gland mucoepidermoid carcinoma but should be part of differential diagnosis. Extensive review of patient’s past medical history plays a crucial role in correctly classifying these lesions as primary or metastatic. Differential diagnoses should include primary squamous cell carcinoma, mesothelioma, and the rare primary mucoepidermoid carcinoma of pleura.

Immunocytochemistry as a Diagnostic Procedure of Pleural Mesothelioma

Background: Mesothelioma is a primary malignant tumor arising from the mesothelial surface of the pleura, peritoneal, tunica vaginalis, and pericardium. Most cases of mesothelioma originate from the pleura. Most patients have a history of asbestos exposure. A common diagnostic problem is distinguishing mesothelioma from adenocarcinoma since both tumors invade the pleura. Immunocytochemistry of calretinin and TTF-1 can be used to establish the diagnosis of mesothelioma.Case: Male, 56 years old presented with chest pain, shortness of breath, cough, and weight loss since 5 months before hospitalization. The patient had a history of occupational exposure to asbestos for 30 years. The movement and breath sounds were decreased as well as dull upon percussion at the right chest. A chest X-ray revealed a right lung tumor with pleural effusion. Thorax CT scan suggested pleural mass in right hemithorax, infiltration to intercostal muscles, and destruction of the 7th right rib, right perihilar lymphadenopathy, right pleural effusion, and liver nodules according to mesothelioma T4N1M1 Stage IV. Infiltrative stenting of the right and inferior lobe of the right lung, infiltrative and obstructive stenting of the medius lobe suggestive of a chronic malignancy and inflammation were found on FOB. Cytologic examination of pleural fluid, sputum, and Washing-and-brushing of FOB were a class II (no malignant cells). USG-guided transthoracic FNAB revealed adenocarcinoma with differential diagnosis of mesothelioma. Immunocytochemistry with calretinin showed positive results and TTF-1 showed a negative result. These confirmed the diagnosis of pleural mesothelioma T4N1M1 Stage IV. The patient showed a stable response from carboplatin/gemcitabine treatment.Keyword : Mesothelioma, Immunocytochemistry, TTF-1, Calrenitin

Utility of pleural fluid adenosine deaminase in diagnosing tubercular pleural effusion: a prospective observational study in a tertiary care hospital

Background: The diagnosis of Tubercular (TB) pleural effusion continues to be a challenge in clinical practice, as traditional diagnostic methods are useful but do not provide enough sensitivity and specificity.Methods: This was a prospective observational study carried out at Tertiary care Hospital with study population of 76 patients. Etiological diagnosis was based on clinical history with radiological imaging, biochemical and cytological examination of pleural fluid. Pleural fluid ADA was used as a biomarker for the diagnosis of tubercular pleural effusion.Results: The study included 76 patients with 69.7% (n=53) males and 30.3%(n=23) females. The mean age of patients was 48.97 17.03 years. Of 76 cases of pleural effusion, 62 were exudates and 14 transudates. Tuberculosis was the most common cause among exudates which accounted for 51.3% (n=39) of cases. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV), Accuracy of pleural fluid ADA in diagnosing tubercular pleural effusion was 92.3%, 97.3%, 97%, 92% and 94.7% respectively.Conclusions: Pleural fluid ADA can be one of the most reliable biomarkers for the diagnosis of TB pleural effusion considering its high sensitivity and specificity.

Non-small Cell Carcinoma of Lung in a 19-year-old Male Presented as Malignant Pleural Effusion

Bronchial carcinoma is rare in younger age group. Smoking, environmental and occupational exposure are the major risk factors. Radiological imaging, bronchoscopy, FNAC and biopsy are the main mode of investigations. Surgery, radiotherapy and chemotherapy are the treatment of choice. Here, we report a case of 19-yearrs-old male and diagnosed as a case of non-small cell carcinoma of lung (NSCC). Cytological examination of pleural fluid showed non-small cell carcinoma. This may be indicating the changing trend of developing NSCC in young adults.&#x0D; Bangladesh Med J. 2018 May; 47 (2): 41-43

P2.03-03 Landscape of Gene Fusions in Lung Adenocarcinoma Patients with Minimal Cigarette Exposure Identified on Malignant Pleural Effusions

Gene fusions in lung adenocarcinoma (LuAD) involving tyrosine kinase receptors such as ROS1, ALK or RET are recurrent oncogenic drivers (∼10%), enriched in light or never-smokers. Some of them represent emerging and predictive biomarkers for targeted therapies. Here we report the fusions detected in a cohort of metastatic LuAD patients with low tobacco exposure (never or former-smokers). Patient-derived cancer cell lines (PDC) were successfully established from malignant pleural effusions from 11 patients diagnosed with LuAD. We assessed the genetic and molecular profile by whole-exome sequencing (WES) and RNA sequencing (RNA-seq) in each cell line. Patients’ characteristics: median age, 58 (39-86); 9 were female. Eight of eleven were never-smokers and three, former-smokers. Seven patients were treatment naïve when pleural effusion samples were collected. A cytological examination of pleural fluid was performed by a lung pathologist and all samples were positive for malignant cells. Known driver mutations in lung primary tumours included one ALK translocation detected by FISH and three EGFR Del19 mutations by targeted sequencing. The three EGFR-mutant LuAD patients progressed to first or second-generation EGFR-TKI and we were able to stablish paired PDC after progressing to tyrosine kinase inhibitors (TKI) in two of them. We identified an acquired FGFR3-TACC3 fusion in one paired PDC after gefitinib progression (T790M-negative), that led to overexpression of FGFR3 concurrent with an enrichment of squamous cell lineage transcripts (e.g. TP63, SOX2) and MDM2 amplification. Among EGFR wild type (wt) patients, two RET rearrangements, CCDC6-RET and KIF5B-RET, and one EML4-ALK fusion -also detected in the primary tumour- were identified in PDC models. In addition, in two of the samples we discovered novel gene fusions that will be described in detail, involving proteins that are not kinases, and thus, their potential role in cancer is still unknown. In this cohort enriched with never-smoking LuAD patients presenting pleural effusions at diagnosis, the presence of known driver fusions during the disease’s course detected by RNA-Seq was 36% (4/11), including a FGFR3-TACC3 fusion as an acquired resistance mechanism to EGFR-TKI. Further study is ongoing in our PDC models to test the functional role of these fusions in order to facilitate precision medicine.

541P - Role of cancer ratio and carcinogenic embryonic antigen ratio in diagnosis of pleural effusion

Background: Pleural effusion results from either malignant or nonmalignant conditions, cytological examination of pleural fluid is diagnostic only in about 50% of malignant pleural effusions. Cancer ratio (serum serum lactate dehydrogenase (LDH)/pleural adenosine deaminase (ADA) may be helpfull in cancer diagnosis of patients with exudative pleural effusion, we investigated this issue along with CEA ratio (pleural CEA/serum CEA) Methods: This study included 60 patients referred to Clinical Oncology & Nuclear Medicine and Chest Departments Menoufia University hospital in the period from January 2016 to January 2017 presented with exudative pleural effusion the mean age was 67.20 + 11.12. 33 patients out of 60 were males and 27 were females, patients were classified into 3 groups, group I included 20 patients with malignant plueral effusion, group II included 20 patients with tuberculous pleural effusion and group III included 20 patients with parapneumonic pleural effusion. The cancer patients group included stage IV disease: 10 patients had bronchogenic carcinoma, 2 patients had pleural mesothelioma, 5 patients had breast cancer and 3 patients with ovarian cancer. All patients underwent thoracentesis and cytology, Serum LDH, pleural ADA, serum and pleural CEA were done then data was statistically analyzed and the cut off value for cancer ratio and CEA ratio was done Results: Cancer ratio was significantly higher in the patients with malignant pleural effusion 59.32 ± 8.19 than the tuberculous group 5.72 ± .15 than patients with parapneumonic effusion 10.30 ± .79, (p < 0.001). CEA ratio was significantly higher in malignant group 4.17 ± .47 than parapnemonic group 2.88 ± .27 than tuberculous group 1.16 ± .08, (p < 0.001). 1 year survival in all patients was (86.6%) and in cancer patients group (80%), there was no statistically significant difference in survival between different primary cancer sites (P > 0.05). in all groups, the mean cancer ratio 19.8188 ± 3.41536 in survived patients compared with 59.5548 ± 18.51138 in non survived patients, the difference was significant (p < 0.01), also the mean CEA ratio 2.4238± .22462 in survived patients compared with 4.8050± .78987 in non survived patients (p < 0.01). Furthermore cancer ratio at cut off point (5.03) can discriminate malignant pleural effusion with sensitivity of 100% and a specificity of 87% while CEA ratio can detect malignant pleural effusion at cut off point (2.53) with sensitivity of 75% and a specificity of 40% Conclusions: Cancer ratio at cut off point (5.03) is a simple method which can discriminate malignant pleural effusion with sensitivity of 100% and a specificity of 87%. Legal entity responsible for the study: menoufia university Funding: None Disclosure: All authors have declared no conflicts of interest.

Role of ultrasonography in the diagnosis of pleural effusion

BackgroundTransthoracic ultrasonography (TUS) represents a useful diagnostic tool in the management of pleural diseases. It is the best method for guiding interventional procedures in the pleural space.ObjectivesThe aim of this study was to detect the role of ultrasonography (US) in the diagnosis and management of pleural effusion in comparison with computed tomography (CT).Patients and methodsPatients with suspected clinical and radiological evidence of pleural effusion were included. Routine laboratory investigations, chest radiography, CT of the chest, TUS, and thoracentesis with biochemical, bacteriological, and cytological examination of pleural fluid were carried out for all patients, and medical thoracoscopy and US-assisted interventions were carried out whenever needed.ResultsEighty-four patients were included in the study. Male patients represented 56% (47 cases), whereas female patients constituted 44% (37 cases); their mean age was 51.21±14.1 years (range: 14–80 years). Seventy-three (86.9%) cases had exudative effusions; inflammatory causes (n=33) and malignancy (n=31) were the most common. TUS was equal to CT in the detection of pleural effusion, pleural thickening, hydropneumothorax, pleural nodule, and consolidation. Moreover, US was better than chest radiography in the detection of pleural thickening, encysted pleural effusion, pleural mass, and consolidation. US was better than CT in the detection of septations (n=30 vs. 5). However, CT was better than US in the detection of loculation (n=28 vs. 17) and pulmonary mass (n=8 vs. 4). Thorcoscopy was performed for nine patients, and was better than US and CT in the detection of pleural nodules.ConclusionTUS is an efficient, quick, inexpensive, radiationfree method for the evaluation of pleural diseases.

Diagnosis and management options in malignant pleural effusions.

Malignant pleural effusion (MPE) denotes an advanced malignant disease process. Most of the MPE are metastatic involvement of the pleura from primary malignancy at lung, breast, and other body sites apart from lymphomas. The diagnosis of MPE has been traditionally made on cytological examination of pleural fluid and/or histological examination of pleural biopsy tissue that still remains the initial approach in these cases. There has been tremendous advancement in the diagnosis of MPE now a day with techniques i.e. characteristic Ultrasound and computed tomography features, image guided biopsies, fluorodeoxyglucose-positron emission tomography imaging, thoracoscopy with direct biopsy under vision, tumor marker studies and immunocytochemical analysis etc., that have made possible an early diagnosis of MPE. The management of MPE still remains a challenge to pulmonologist and oncologist. Despite having various modalities with better tolerance such as pleurodesis and indwelling pleural catheters etc., for long-term control, all the management approaches remain palliative to improve the quality of life and reduce symptoms. While choosing an appropriate management intervention, one should consider the clinical status of the patient, life expectancy, overall cost, availability and comparative institutional outcomes, etc.

Dyspnea: when the preliminary imaging is unconvincing

A 73-year-old man was admitted to the Emergency Room (ER) for dyspnea and cough from several months. In ER were performed blood sampling, chest X-ray, electrocardiogram, echocardiogram and arterial blood gas. A thoracic ultrasound (US) revealed in the left side an abundant pleural effusion and a lung consolidation area of about 5 cm without air bronchogram. A thoracentesis showed the presence of hemorrhagic effusion. Chest computed tomography (CT) revealed micro-pulmonary embolism, abundant left pleural effusion with atelectasis of the lower ipsilateral lobe. Meanwhile the chest CT revised by the pulmonologist appeared suspicious for the presence of cancer, the cytological examination of pleural fluid revealed the presence of an adenocarcinoma. While the patient was waiting for the bronchoscopy he had a stroke and died in a few days. In conclusion, we believe that thoracic US has to be considered an extension of the physical examination, it is a bedside tool and it represents a valid diagnostic and therapeutic method. Therefore thoracic US, if closely linked to the physician’s activity, can directly affect the decision-making process and management of the patient with dyspnea.

Cytomorphology of Boerhaave's syndrome: A critical value in cytology

Spontaneous esophageal perforation into the pleural cavity (Boerhaave's syndrome) is a rare life-threatening condition, which requires early diagnosis and urgent management. The diagnosis of such critical condition in many cases is delayed because of atypical clinical presentation, resulting in increased morbidity and mortality. Cytological examination of pleural fluid can provide early, fast and accurate diagnosis of such critical condition and help in better and early management of this disease. We describe a case of an 81-year-old female with esophageal perforation who presented with a left sided pleural effusion. The correct diagnosis was established in this case by observing gastrointestinal-like fluid characteristics of the thoracic drainage upon cytological and chemical analyses and the rupture was confirmed by esophagography. The cytological examination of pleural fluid revealed benign reactive squamous cells, fungal organisms, bacterial colonies, and vegetable material consistent with a ruptured esophagus. Cytological examination of pleural fluid is a rapid and accurate technique that can help in establishing the diagnosis of this challenging entity and guide initiation proper management of this unusual entity.

198 Is cytological examination of pleural fluid obtained at VATS for suspected malignant pleural effusion useful?

198 Is cytological examination of pleural fluid obtained at VATS for suspected malignant pleural effusion useful?

Comparing the results of VATS pleurectomy and talc pleurodesis with small sized catheter in randomised patients with malign pleural effusion

Objectives: Pleural effusion occurs as a result of detoriation in equilibrium between absorption and secretion. We aimed to investigate the clinical responses of talk pleurodesis and pleurectomy with video assisted thoracoscopic surgery (VATS) in patients with malignant pleural effusion. Materials and methods: Forty-five patients with malignant pleural effusion between June 2007 and June 2008 were included in this study. Thoracentesis was performed in order to study the biochemical, microbiologic, cytological analysis. Glucose, total protein, albumin, lactic dehydrogenases and cytological examination were studied in effusion and blood sample simultaneously. Cases were classified into two groups; in group I (n=25), small calibrated catheter and talk pleurodesis were performed. In group II (n=20), VATS pleurectomy was performed. Results: There were 32 females and 13 males with mean age 51.58 (27-75) years. Diagnosis was made with cytologic examination of pleural fluid that was aspirated with thoracentesis. Transudate- exudate discrimination was done according to Light’s criteria. Success rates of the groups were as complete response; 84% (n=21) in group I, 85% (n=17) in group II. Unsuccessful response was 16% (n=4) in group I and 15% (n=3) in group II. There was no statistically significant difference between hospital stay and tube duration of groups when compared to each other. Conclusion: The treatment of malignant pleural effusion is palliative due to poor prognosis. The purpose is to eliminate dyspnea in patients with short survival time. There was no significant difference between the VATS pleurectomy and talc pleurodesis that has been known as effective sclerosant agent.

Microsatellite Alterations and Cell-Free DNA Analysis: Could They Increase the Cytology Sensitivity in the Diagnosis of Malignant Pleural Effusion?

The exact diagnosis of malignant pleural effusions (PE) is difficult and often requires combined procedures, because the cytological examination of pleural fluid does not detect tumoral cells in 40% of malignant effusion cases. The aim of this study was to analyze microsatellite alterations (MA) in malignant PE and to determine their diagnostic value as an additional test to cytological examination. The increase in cell-free DNA levels was also evaluated as a signal of probable malignancy. A total of 84 patients with PE were enrolled and underwent PE and whole blood and exhaled breath condensate analyses. Free DNA was measured by spectrophotometer analyses. DNA was extracted from all samples and analyzed for MA, using the microsatellite markers at chromosomes 3p, 12p, 5q, and 17p. The microsatellite analysis of PE exhibited a higher percentage of alterations in malignant PE than in benign PE. In addition to this, cell-free DNA in PE was seen to be significantly more elevated in malignant than in benign PE. The sensitivity of the sole cytology increased considerably when patients showed at least one MA or DNA>4 ng/μL in the PE. In conclusion, it was seen that the combination of the cytological examination with microsatellite analyses and cell-free DNA in pleural fluid could increase the sensitivity of the diagnosis in patients with PE who have a suspected malignancy, obviating the need for other invasive diagnostic procedures.

Dyspnoea, cough, edema: Heart failure or what else?

We present the case of a 55-year-old man admitted for dyspnea, cough and edema of the legs and feet. The patient, a smoker with psoriasis at hands and feet noted the comparison, three years ago, of marked thickening and yellow discoloration of the nails. The chest X-ray showed a right-sided pleural effusion with parenchymal atelectasis. The cytologic examination of pleural fluid revealed mesothelial cells with inflammatory changes. The bacterial culture of the pleural fluid was negative and pleural biopsies revealed fibrosis. To reduce dyspnoea and formation of pleural fluid, was performed a pleurodesis by talcage. The patient was discharged with itraconazole, high dose vitamin E and zinc supplements as home therapy. The correct diagnosis was not easily achieved because the patient had symptoms and signs referable to other diseases as heart failure or venous insufficiency or psoriasis.