Diagnosis Of Malignant Pleural Effusion Research Articles

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.

Assessment of a panel of miRNAs in serum and pleural fluid for the differential diagnosis of malignant and benign pleural effusion.

Differential diagnosis between malignant pleural effusion (MPE) and benign pleural effusion (BPE) remains a clinical challenge. The aim of the study is to assess the efficacy of the serum and pleural fluid (PF) miRNA panels in distinguishing MPE from BPE. Fourteen candidate miRNAs which were shown aberrant expression in lung cancer based on previous studies were tested by quantitative real-time PCR (qRT-PCR) in 20 MPE patients and 20 BPE patients. Significantly aberrantly expressed miRNAs were further assessed by qRT-PCR in all patients enrolled in this study. A receiver operating characteristic (ROC) curve was constructed, and the area under the ROC curve (AUC) was calculated to evaluated the diagnostic performance of the miRNAs. miR-21, miR-29c and miR-182 were found to be significantly aberrantly expressed in the serum and PF of MPE patients. The AUCs for the combination of miR-21, miR-29c and miR-182 in serum and PF were 0.832 and 0.89 respectively in distinguishing MPE from infection-associated PE including tuberculous pleurisy and parapneumonia PE, and 0.866 and 0.919 respectively for differentiating MPE from heart failure-associated PE, which were superior to AUC of each individual miRNAs. miR-21, miR-29c and miR-182 in serum and PF could be useful biomarkers for diagnosis of MPE.

Diagnostic sensitivity of pleural fluid cytology in malignant pleural effusions: systematic review and meta-analysis

BackgroundPleural fluid cytology is an important diagnostic test used for the investigation of pleural effusions. There is considerable variability in the reported sensitivity for the diagnosis of malignant pleural effusions...

The role of LENT and PROMISE scores in predicting survival in malignant pleural effusion.

Background:Malignant pleural effusion (MPE) is a condition, that can be seen in 15% of patients diagnosed with cancer. Because of the short overall survival, it is important to identify the appropriate treatment. In addition to the palliation of secondary symptoms due to MPE, it should also be decided in which cases a more aggressive treatment is to be followed. The purpose of the study was to evaluate the performance of LENT and clinical PROMISE scores in predicting survival in patients with MPEMethods:Age, sex, smoking history, Eastern Cooperative Oncology Group (ECOG) score, cancer type, history of chemotherapy/radiotherapy, laboratory values, and pleural fluid lactate dehydrogenase were recorded. The LENT and the PROMISE scores were calculated and risk categories were determined. During the follow-up, blood tests and tomography controls were performed on the patients as routine. The overall survival was calculated as the period from the date of diagnosis of MPE to death or until December 31, 2019Results:A total of 169 patients were included. The median age was 65 (26–86). In the single-variable analysis, there was a significant increase in mortality risk in the poor performance score and if the LENT risk group progressed from the low-to medium-/high-risk group or PROMISE categories A to B, A to C or A to D. In multivariate analysis, mortality risk in 1, 3, 6, and 12 months increased significantly in poor performance score, in PROMISE category B, C, and D. In high LENT risk-group, an increased mortality risk was shown in only 12 months of survivalConclusions:Our data show that poor performance score (ECOG 3-4), PROMISE category B, C, and D significantly increase mortality risk and the LENT score is inadequate in predicting survival.

Review article on indwelling pleural catheter

Lymphomas, malignancies of the lung, breast, and ovaries, most frequently give rise to malignant pleural effusions (MPE). The prognosis is often bad when an MPE is present. Malignant cells found in the pleural fluid or tissue can be used to confirm the diagnosis of MPE. Palliative care should emphasize on symptom relief, quality-of-life enhancement, and acceptance of an initial intervention to drain an MPE or prevent recurrence and affordability. Our preferred initial treatment for the majority of patients with recurrent MPE is the placement of an IPC (also known as a tunneled pleural catheter), with intermittent outpatient drainage performed by the patient or attender. Patients with expandable lung are candidates for both IPC drainage and pleurodesis, but those with nonexpandable lung are often only eligible for IPC drainage. IPC requires interventional expertise and may not be available in some institutions. IPC can produce spontaneous pleurodesis and gives good symptom alleviation, according to many randomized trials and one meta-analysis. Effective pleurodesis occurs in up to 70% of patients.

Pleural Biopsy in Evaluation of Malignant Pleural Effusion- A Review

Malignant pleural effusion (MPE) is one of the common presentation of many carcinoma including lung, breast and lymphomas. It is very important to make an etiological diagnosis of the MPE cases without any delay as treatment depends on its cause. Cytopathological examination of fluid for malignant cells is the easiest and most sensitive method for detecting malignant pleural effusion (MPE). Despite cytology being a sensitive test, many patients remain undiagnosed, then there is a need of histopathological examination of pleura. Invasive procedures like Closed pleura biopsy (CPB) or thoracoscopy was recommended. CPB was earlier considered an investigation of choice in cases of undiagnosed pleural effusion with good efficacy Since the emergence of medical thoracoscopy (MT), use of CPB in the diagnosis of cytology negative MPE is gradually declining. However, due to the high cost and challenges associated with the surgery, thoracoscopy is only used in a restricted number of cases. CPB is less reliable than cytopathological testing of fluid or MT in determining MPE. Yet, it is a simple procedure with little procedure -related complication. The purpose of this article is to assess the clinical presentation and approach to MPE, as well as the role of CPB in diagnosing MPE and to investigate the benefits and drawbacks of CPB.”

Development and Validation of a Scoring System for Early Diagnosis of Malignant Pleural Effusion Based on a Nomogram.

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.

Merkel Cell Carcinoma Presenting as a Malignant Pleural Effusion Post-COVID-19 Hospitalization: a Case Report and Literature Review

Abstract Introduction/Objective Merkel cell carcinoma (MCC) is a rare, highly aggressive neuroendocrine carcinoma of the skin, associated with immunosuppression, UV light exposure, and the Merkel cell polyomavirus (MCPyV). Metastatic MCC diagnosed in body fluid cytology is extremely rare. Here, we report on a case of a 65-year-old male presenting with a right pleural effusion and a remote history of MCC, unknown to us during the cytologic evaluation of the effusion. To the best of our knowledge, this is the sixth case of metastatic MCC diagnosed in body fluid cytology reported in English literature, and the first one reported in a patient previously admitted for COVID-19 pneumonia. Methods/Case Report A 65-year-old male presented with dyspnea and acute hypoxic respiratory failure. Past medical history was significant for squamous cell carcinoma of the right forearm excised four months prior and ulcerative colitis. The patient had two recent hospitalizations for COVID-19 pneumonia. Chest x-ray on admission demonstrated an enlarged, loculated right pleural effusion. Emergent thoracentesis was performed and 1500 cc of bloody pleural fluid was sent for cytology. The patient’s respiratory status improved. A ThinPrep and a cell block were prepared. Both displayed clusters of small round blue cells with hyperchromatic nuclei, scant cytoplasm, and fine chromatin in a background of rare mesothelial cells, macrophages, and numerous lymphocytes. Immunohistochemical (IHC) studies showed CK20, AE1/AE3, and CAM 5.2 in a perinuclear dot-like staining pattern. CD56, chromogranin, and synaptophysin were also positive. Ki-67 proliferative index was about 40%. TTF-1 was negative, while CD45 highlighted background lymphocytes. The primary care physician was contacted and the patient’s past medical history was significant for MCC. Subsequent MCPyV and SATB2 demonstrated nuclear positivity in the tumor cells. Diagnosis of MCC was done. Results (if a Case Study enter NA) NA Conclusion MCC is a highly aggressive malignancy rarely reported in body fluids. MCC should be included in the differential diagnosis of malignant pleural effusions, especially in cases of the small blue round cells. Using IHC, like CK20 and neuroendocrine markers including the newer SATB2, can lead to an accurate diagnosis. Additional reporting of such cases may increase awareness, especially where prior history is not readily available, such as in this present instance.

APPLICATION OF THE PROMISE SCORE AS A PREDICTOR OF SURVIVAL IN MALIGNANT PLEURAL EFFUSIONS

TOPIC: Disorders of the Pleura TYPE: Original Investigations PURPOSE: Onset of a malignant pleural effusion (MPE), whether as a newly diagnosed malignant disease or as progression of an already known malignancy, is an important marker for rapid clinical deterioration. This motivates a need to reassess prognosis, not only to better explain the clinical significance of events to the patient, but also to weigh in on treatment options. The PROMISE Score for MPE predicts a 3-month mortality rate for this population. We assessed the clinical application of the PROMISE score and analyzed predictors of survival in our center. METHODS: Retrospective study including patients with confirmed MPE. PROMISE score was calculated using hemoglobin levels, serum white blood cells count, serum C-Reactive Protein levels, ECOG Performance Status, cancer type and a history of previous chemotherapy and/or radiotherapy. Each patient was assigned a 3-month mortality rate according to their Clinical PROMISE Score: Group 1 (Score: 0-20), <25% mortality; Group 2 (Score: 21-27), 25 to <50% mortality; Group 3 (Score: 28-35), 50 to <75% mortality; and Group 4 (Score: >35), ≥75% mortality. Survival was determined by Kaplan-Meier curves and compared by log-rank test. A multivariate analysis was performed using Cox proportional hazard model. RESULTS: We studied a total of 273 patients, divided as follows according to PROMISE score: Group 1 (n=97), Group 2 (n=95), Group 3 (n=74) and Group 4 (n=7); 50.5% of the patients were male, and mean age at MPE diagnosis was 67.1±12.9 years old. Two-thirds of the patients had an ECOG <2. More than half (57.2%) the patients had a large-volume pleural effusion at the time of diagnosis; lung was the most frequent primary malignancy site (52.7% vs 47.3% non-pulmonary malignancies). Treatment strategies were continued in 64.1% of all patients; a best supportive care strategy was opted for the remaining 35.9%. Overall median survival was 95 (95%CI, 70.6-117.4) days. Median survival was significantly different between PROMISE score risk groups (p<.001): 275 (95%CI, 180.1-369.1) days in Group 1, 95 (95%CI, 70.4-119.6) days in Group 2, 22 (95%CI, 12.6-31.4) days in Group 3 and 10 (95%CI, 4.9-15.1) days in Group 4. After adjusting for age, sex and cancer-treatment, PROMISE score was an independent predictor of survival among patients of all risk groups (Group 2 vs Group 1: HR 2.24 [CI 95%, 1.64-3.06]; Group 3 vs Group 1: HR 4.17 [CI 95%, 2.93-5.95]; Group 4 vs Group 1: HR 7.07 [CI 95%, 3.11-16.08]; p<.001). Mortality rates at the 3-month mark were as follows: 22.7% mortality in Group 1; 47.4% mortality in Group 2; 81.1% mortality in Group 3; and 100% mortality in Group 4. CONCLUSIONS: The PROMISE score demonstrated to be a valuable tool for predicting survival among MPE patients. In respect to 3-month mortality rates, our sample maintained a similar risk stratification as the one originally proposed by the PROMISE score, with a tendency towards the higher thresholds. CLINICAL IMPLICATIONS: Usage of the PROMISE score in the context of newly diagnosed MPE provides an important risk stratification and enables the clinician to better reassess prognosis in this subset of patients. By accurately predicting 3-month mortality rates, its application helps clinicians in the treatment decision process, identifying those patients more likely to benefit from supportive measures alone, such as repeat thoracentesis, rather than definitive treatment options like pleurodesis or tunneled catheter placement. DISCLOSURES: No relevant relationships by Helder Bastos, source=Web Response No relevant relationships by David Coelho, source=Web Response No relevant relationships by maria gabriela fernandes, source=Web Response No relevant relationships by Claudia Freitas, source=Web Response No relevant relationships by maria magalhães, source=Web Response No relevant relationships by Pedro Magalhães Ferreira, source=Web Response No relevant relationships by Beatriz Martins, source=Web Response no disclosure on file for Natália Melo; No relevant relationships by Mariana Serino, source=Web Response No relevant relationships by Rita Trovisco, source=Web Response

Value of PET/MRI in the diagnosis of malignant pleural effusion in comparison with PET/CT

Objective: To investigate the diagnostic value of PET/MRI for malignant pleural effusion (MPE), and compare its diagnostic difference with PET/CT. Methods: The data of 57 patients with suspected MPE admitted into Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from October 2017 to January 2020 was analyzed. A total of 53 patients were included in the prospective study, and the whole body PET/CT and thoracic PET/MRI were performed on them respectively. Two physicians used a blind method to evaluate the morphological features of PET/CT and PET/MRI images, delineate the region of interest (ROI), obtain the maximum standard uptake value (SUVmax) of the ROI in the PET/CT and PET/MRI images. The target-to-background ratio (TBR) of the lesion was calculated. The diffusion-weighted imaging (DWI) characteristics of the pleura in PET/MRI images were analyzed. Taking pathological diagnosis as the gold standard, the diagnostic effect of PET/CT and PET/MRI on MPE were evaluated. Results: The 53 patients who were finally included were (62.8±1.7) years old, consisting of 31 males. Pathological results showed that 41 cases were MPE and 12 cases were benign pleural effusion (BPE). There were no statistical differences in age, gender and smoking history between the two groups (P>0.05). Bland-Altman analysis showed that the SUVmax of pleural lesions by PET/MRI was higher than that by PET/CT (6.4±0.6 vs 5.3±0.5, P<0.001). The TBR of PET/MRI was higher than that of PET/CT (2.2±0.2 vs 1.8±0.2, P<0.001). The sensitivity, specificity, and accuracy of PET/MRI in the diagnosis of MPE by combining imaging features such as SUVmax and DWI of pleural lesions were 75.6%, 100%, and 81.1%, respectively. The sensitivity, specificity, and accuracy of PET/CT combined with SUVmax and imaging features of pleural lesions in the diagnosis of MPE were 85.4%, 83.3%, and 77.4%, respectively. There was no statistically significant difference between PET/MRI and PET/CT in the area under the curve (AUC) for diagnosing MPE (0.934 vs 0.873, P>0.05). Conclusions: PET/MRI and PET/CT have the equivalent diagnostic efficiency for MPE. However, PET/MRI shows higher SUVmax and TBR for pleural lesions, and has specific pleural DWI imaging characteristics, which is worthy of further clinical research.

Cytologic Investigations for the Diagnosis of Malignant Pleural Effusion in Non-small Cell Lung Cancer: State-of-the-art Review for Pulmonologists.

Lung cancer is the current leading cause of cancer-related deaths worldwide, and malignant pleural effusion, an indicator of the advanced stage of this disease, portends a poor prognosis. Thus, making an accurate diagnosis of malignant pleural effusion is of paramount importance. During the past decade, the prognosis of patients with advanced non-small cell lung cancer has improved substantially, especially in those treated with targeted therapy and immunotherapy. The use of pleural fluid cytology should not only provide diagnoses but also aid in the selection of targeted therapies, especially when obtaining a histologic specimen is too difficult. In this evidence-based review, we address the importance of pleural fluid cytology in non-small cell lung cancer patients, from making the diagnosis to making treatment-related decisions when only pleural fluid is available.

A rapid calprotectin test for the diagnosis of pleural effusion.

In previous studies, measuring the levels of calprotectin in patients with pleural effusion (PE) was an exceptionally accurate way to predict malignancy. Here, we evaluated a rapid method for the measurement of calprotectin levels as a useful parameter in the diagnosis of malignant pleural effusion (MPE) in order to minimise invasive diagnostic tests. Calprotectin levels were measured with Quantum Blue® sCAL (QB®sCAL) and compared with the gold standard reference ELISA method. Calprotectin levels in patients with benign pleural effusion (BPE) were significantly higher (p < 0.0001) than for MPE patients. We measured the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LRs) for a cut-off value of ≤ 14,150 ng/mL; the diagnostic accuracy was 64%. The odds ratio for PE calprotectin levels was 10.938 (95% CI [4.133 - 28.947]). The diagnostic performance of calprotectin concentration was better for predicting MPE compared to other individual parameters. Comparison of two assays showed a slope of 1.084, an intercept of 329.7, and a Pearson correlation coefficient of 0.798. The Bland-Altman test showed a positive bias for the QB®sCAL method compared to ELISA fCAL®. Clinical concordance between both these methods was 88.5% with a Cohen kappa index of 0.76 (95% CI [0.68 - 0.84]). We concluded that QB®sCAL is a fast, reliable, and non-invasive diagnostic tool for diagnosing MPE and represents an alternative to ELISA that could be implemented in medical emergencies.

Role of cancer ratio and other new parameters in the differential diagnosis of malignant pleural effusion

OBJECTIVES:We compared the diagnostic potential of cancer ratio (CR, serum lactate dehydrogenase [LDH]/pleural fluid adenosine deaminase [pfADA]), cancer ratio plus (CR plus, cancer ratio/pleural lymphocyte percentage), and age/pfADA ratio with pfADA in malignant pleural effusion.METHODS:Data from 100 patients with malignant pleural effusion (MPE) and 119 patients with tuberculous pleural effusion (TPE) were retrospectively collected. PfADA, age/pfADA ratio, CR, and CR plus were compared between patients with MPE and those with TPE in two age groups (≤50 and >50 years). The best cut-off value was determined, and the diagnostic performance was evaluated according to the receiver operating characteristic curve.RESULTS:PfADA was statistically significantly lower while age/pfADA ratio, CR, and CR plus were significantly higher in the MPE group than in the TPE group in both age groups (p<0.05). For patients aged ≤50 years, the differential diagnostic value of pfADA for MPE was better than those of age/pfADA ratio, CR, and CR plus. At a cut-off value of 13.0 U/L, the sensitivity, specificity, and accuracy were 88.9%, 100.0%, and 98.9%, respectively. For patients aged >50 years, the diagnostic performance of CR plus was superior to those of pfADA, age/pfADA ratio, and CR. At a cut-off value of 22.6, the sensitivity, specificity, and accuracy of CR plus for the diagnosis of MPE were 86.8%, 84.6%, and 86.2%, respectively.CONCLUSIONS:The best parameter for diagnosing MPE was different for patients aged ≤50 years and >50 years. For patients aged >50 years, CR plus was a good parameter for the differential diagnosis of MPE. For patients aged ≤50 years, pfADA was better.

Role of conventional cytology and cell block methods for diagnosis of malignant pleural effusions

Role of conventional cytology and cell block methods for diagnosis of malignant pleural effusions

Management of Malignant Pleural Effusion (MPE) in a Tertiary Hospital in a low-income-country: Challenges and Prospects

Background: In the West African sub-region, significant morbidity and mortality are known to affect patients with malignant pleural effusion (MPE) but are highly under reported unlike USA, Europe or South Africa.Aim/Objective: To review cases of MPE in our tertiary hospital in the last 13 years with a view to determining the challenges and prospects.Materials and Method: This is a retrospective study spanning over a decade from January, 2007 to December, 2019. Malignant pleural effusion from various neoplasms constitutes the commonest thoracic malignancy in our tertiary hospital. After 13 years of management of such patients, we reviewed the data from the hospital record’s department. The data obtained were demography, aetiology, total number of pleural fluid specimens for cytology and pleural biopsies submitted for histology, pleurodesis and other treatment modalities.Result: 211 patients with MPE were admitted and managed during the period under review. Of these numbers, 135(64.0%) were confirmed cytologically positive (MPE). 76(36.0%) tested falsely negative and were initially regarded as paramalignant, later confirmed MPE. The age affected was from 7 to 81 years with a mean of 44 years. Of 211 patients with MPE, 94 were males while 117 were females, with a male to female ratio of 4:5. Aetiologically, metastatic breast cancer was the highest followed by advance lung cancer.Conclusion: Submission of insufficient samples resulted in false negative cytology. Review of recurrent pleural effusion and exophytic tumour at the sites of CTTD resulted in late diagnosis of MPE. Additionally, prolonged hospital stay awaiting CTTD and cytology results are among the challenges.

Easy-to-Use Scoring System Based on CT Pleural Fluid and Blood Features for Discriminating Malignant Pleural Effusions from Tuberculous Pleural Effusions: A Retrospective and Prospective Validation Study

Background: Distinguishing malignant pleural effusion (MPE) from tuberculous pleural effusion (TPE) is a challenge when symptom is atypical. Computed tomography (CT) scans and biochemical indicators are the most commonly used methods to evaluate pulmonary and pleural diseases, and the role of CT features (especially pleural and pleural fluid features) in the diagnosis of MPE or TPE is poorly described. Therefore, this study aims to establish and verify diagnostic models based on the characteristics of pleural and pleural effusion for the differential diagnosis of MPE and TPE. Methods: In this study, a first batch of 986 patients from Wuhan union hospital and Wuhan Jinyintan Hospital in the training set was used to develop differential diagnosis models. The CT features (including maximum pleural thickness at the non-mass/nodule, density of the pleural effusion, pleural mass/nodule, mediastinal pleural involvement, pleural wrap, pleural calcifications) and biochemical markers (including serum carcinoembryonic antigen (CEA), and adenosine deaminase (ADA) in the pleural fluid) were collected and subjected to logistic regression analyses. Then, two models were constructed: a model based on CT features (Model 1) and a model based on pleural fluid markers with or without blood biochemical markers (Models 2a/2b). The differential diagnostic model was displayed in the form of nomograms, which were validated by an independent prospective cohort (N=422). Findings: In the training set, eight variables were selected as significant risk factors for distinguishing MPE from TPE after multivariable regression analyses, i.e. age, sex, maximum pleural thickness at the non-nodule/mass, pleural fluid density, pleural nodule/mass, serum CEA, effusion CEA and effusion ADA. In Model 1, the area under the Receiver Operating Characteristic Curve (AUROC) was 0.970, yielding a sensitivity and specificity of 91.07% and 89.86% respectively in the training set, and AUROC = 0.968, sensitivity and specificity was 93.85% and 87.73% respectively in the validation set. In Model 2a, the AUROC, sensitivity and specificity for distinguishing MPE from TPE were 0.976, 92.73% and 93.66% in the training set, respectively, and 0.959, 93.50% and 87.84% in the validation set, respectively. In Model 2b, the AUROC, sensitivity and specificity for distinguishing MPE from TPE were 0.970, 94.87% and 90.87% in the training set, respectively, and 0.962, 96.77% and 80.25% in the validation set, respectively. There were no significant differences between the three models. Interpretation: CT features of pleura and pleural fluid could effectively help physicians differentiate between MPE and TPE, which were readily acquired and could be used as a non-invasive and convenient diagnostic tool in clinical practice. Trial Registration: This study was registered on the Clinical Trials website (No. NCT03997669). Funding Statement: This research was supported by the National Natural Science Foundation of China (No. 81770096; No. 81800094), the National Science and Technology Key Project (No. 2019ZX09301001). Declaration of Interests: The authors declare no competing non-financial/financial interests. Ethics Approval Statement: This study was approved by the Institutional Review Board of the Tongji Medical College, Huazhong University of Science and Technology, and supported by the Wuhan Clinical Research Center for Pleural Diseases

Critical analysis of the utility of initial pleural aspiration in the diagnosis and management of suspected malignant pleural effusion

IntroductionCurrent guidelines recommend an initial pleural aspiration in the investigation and management of suspected malignant pleural effusions (MPEs) with the aim of establishing a diagnosis, identifying non-expansile lung (NEL) and,...

Video-assisted thoracoscopy in the diagnosis and treatment of malignant pleural disease

: The malignant pleural effusion is a common clinical issue, connected with metastatic tumors or with primary tumor of the pleura. This narrative review focuses on the video-assisted thoracic surgery (VATS) diagnostic approach and treatment modalities for management of malignant pleural effusion. We conducted searches for clinical studies and guidelines through Medline, Embase and Cochrane Library. Limiting the search to the last decade, we selected 29 papers: 5 randomized controlled trials, 9 prospective cohort studies, 11 retrospective studies, 3 guidelines and 1 survey. Malignant pleural effusion frequently affects the clinical evolution of patients with metastatic cancer and proper diagnosis in low risk patients is mandatory in the era of target therapy. Pleural biopsy, performed through pleuroscopy or VATS remains the gold standard for the diagnosis of malignant pleural effusion. The non-intubated VATS is a good combination of surgical skills and anaesthesiological management that could avoid risks of general anesthesia. The type and number of surgical access seems have no relevant impact on the short-term outcome. The best treatment to prevent the accumulation of pleural fluid remains the talc poudrage, possibly followed by talc slurry in case of recurrence.

Homocysteine and Carcinoembryonic Antigen as Biomarkers for the Diagnosis of Malignant Pleural Effusion

Homocysteine and Carcinoembryonic Antigen as Biomarkers for the Diagnosis of Malignant Pleural Effusion

Salivary microRNAs show potential as biomarkers for early diagnosis of malignant pleural effusion.

BackgroundMalignant pleural effusion (MPE) is a common medical problem caused by multiple malignancies, especially lung cancers, and always comes along with a poor outcome. Early detection and diagnosis are important for improving the prognosis in patients with MPE. Salivary microRNAs (miRNAs) may represent a relatively convenient way for diagnosing MPE. We investigated the characteristics of salivary miRNAs of MPE patients, benign pleural effusion (BPE) patients, patients with a malignant tumor but without pleural effusion (MT), and healthy controls (HCs). We believe that they may show potential as a non-invasive and convenient biomarker for diagnosing MPE.MethodsFrom January 1, 2019, to July 1, 2019, 57 MPE patients, 33 BPE patients, 50 MT patients, and 49 HCs were enrolled. To select candidate biomarkers, in the discovery phase, the salivary miRNA profiles were detected in three MPE patients and three HCs. Then, qPCR was used in the validation phase with 54 MPE patients, 33 BPE patients, 50 MT patients, and 46 HCs to assay the selected miRNAs.Resultshsa-miR-4484 and hsa-miR-3663-3p were identified as potential biomarkers to diagnose MPE patients, with areas under the curve (AUC) of 0.768 and 0.666, respectively. The diagnostic efficacy was higher when the combination of both miRNAs was used, with an AUC of 0.802. No correlation was found between the volume of MPE and the expression of salivary miRNAs.ConclusionsThis study reports the characterization of salivary miRNAs collected from MPE patients. A combination of hsa-miR-4484 and hsa-miR-3663-3p showed potential discriminatory power for MPE detection, and it may be helpful for the early diagnosis of MPE, i.e., before the pleural effusion volume is too large.