Pleural Fluid Levels Research Articles

Medical thoracoscopy for tuberculous pleurisy: A retrospective analysis of 575 cases.

OBJECTIVE:The objective of this retrospective study was to assess the efficacy of medical thoracoscopy in diagnosing of tuberculous pleurisy and characterize tuberculous pleurisy with medical thoracoscopy.METHODS:A total of 575 patients with tuberculous pleurisy who underwent medical thoracoscopy were included in the study. Demographic data, clinical manifestations, and routine and biochemical tests on pleural fluid, cultures of pleural fluid, sputum, and pleural biopsy for the detection of Mycobacterium tuberculosis and pathological findings were evaluated.RESULTS:Sputum, pleural fluid, and pleural biopsy cultures were positive for M. tuberculosis in 12.5%, 19.2%, and 41.9% of patients, respectively. Furthermore, there were significant differences in total positive tuberculosis (TB) tests in the pleural cavity according to patient's age (<18 years old, 50.0%; 18–34 years old, 50.2%; 35–59 years old, 34.8%; >60 years old, 18.6%; and all groups vs. >60 years old, P < 0.001). Patients with 18–34 years old were more likely to have granuloma in pleural biopsy specimens when compared to patients >60 years old (77.0% vs. 37.9%). The percentage of patients with high adenosine deaminase (ADA) levels in pleural fluid (>40 U/L), who were <18, 18–34, 35–59, and > 60 years old, was 83.3% (15/18), 72.8% (193/265), 51.2% (88/172), and 34.7% (17/49), respectively (all groups vs. >60 years old, P < 0.001).CONCLUSION:Medical thoracoscopy is effective for diagnosing tuberculous pleurisy. Younger patients with tuberculous pleurisy have a higher number of positive TB tests in the pleural cavity, are more likely to have granuloma in pleural biopsy specimens, and have higher ADA levels in the pleural fluid.

Lactate dehydrogenase levels in pleural fluid of effusive pleural diseases

Lactate dehydrogenase levels in pleural fluid of effusive pleural diseases

Ratio of carcinoembryonic antigen in pleural fluid and serum for the diagnosis of malignant pleural effusion.

Background:Tumour markers in pleural fluid and their diagnostic value are subject to debate. Although there are several studies on this topic, standardized cut-off values do not exist. In this study we investigated the potential of a ratio of carcinoembryonic antigen (CEA) in pleural fluid and serum, serving as an individual marker for pleural cancer manifestation.Methods:A total of 201 consecutive patients with unclear pleural effusion were included in the study; 98 were diagnosed with malignant pleural effusion and 103 had an effusion due to other, benign reasons. CEA levels in pleural fluid and serum were measured.Results:By using receiver operating characteristics analysis, at the cut-off of 1.0, the CEA ratio showed a specificity of 92% and sensitivity of 85%, with a positive predictive value of 91% and a negative predictive value of 87%. These results are higher than in previous investigations on different pleural tumour markers and their combination.Conclusions:The CEA ratio is a useful tool in predicting pleural carcinosis. Elevated results in cytology-negative patients should lead to further investigations, such as repeated cytological examination or thoracoscopy.

Clinicopathological features of immunoglobulin G4-related pleural lesions and diagnostic utility of pleural effusion cytology.

Immunoglobulin (Ig)G4-related disease is a recently described systemic immune-mediated fibro-inflammatory disease that frequently occurs in tumorous form. Herein, we elucidated the clinicopathological and cytological characteristics of IgG4-related pleural lesions (PLs). Among 22 patients with fibro-inflammatory PLs of idiopathic aetiology, eight cases were diagnosed as IgG4-PL and the remaining 14 as non-IgG4-PL according to comprehensive diagnostic criteria for IgG4-related disease. Cell block examination of pleural effusion (CBPE) was performed in five patients with IgG4-PL and in six with non-IgG4-PL. Both groups were compared in terms of clinical presentation, laboratory data, histopathological features of resected pleura, and cytological features of pleural effusion (PE). PE was the most common (six patients, 75%) clinical presentation of IgG4-PL. IgG4-PL comparatively showed significantly more frequent concomitant allergic disease (P=.021), higher serum IgE levels (P = .012), higher adenosine deaminase levels in pleural fluid (P=.005), and rare spontaneous recovery without treatment (P = .046). The IgG4-PL group was histologically characterised by thicker fibrous pleura, storiform fibrosis, and infiltration of regulatory T cells, eosinophils and basophils. Using CBPE, IgG4-PL was cytologically distinct with numerous IgG4+ cells and eosinophils. The cytology of CBPE positively correlated with the histology of pleural tissue in the number of IgG4+ cells and eosinophils (R=.769 and .803, respectively). IgG4-PL frequently presents with PE and is histologically and cytologically characterised by abundant infiltration of IgG4+ cells and eosinophils. We believe that CBPE with immunohistochemistry/special staining could assist in the auxiliary diagnosis of IgG4-PL.

The comparison of pleural fluid TNF-α levels in tuberculous and nontuberculous pleural effusion

BackgroundTuberculous pleural effusion is the manifestation of Mycobacterium tuberculosis infection in pleura. With existing means, it is difficult to establish the diagnosis of tuberculosis (TB) and non-TB pleural effusions; thus, establishing the diagnosis of TB pleural effusion and non-TB pleural effusion is still a clinical problem. Tumour necrosis factor alpha (TNFα) is a potent inflammatory cytokine that plays an important role in immunity to Mycobacterium tuberculosis infections, this level of cytokine increases in pleural effusion due to tuberculosis. ObjectiveTo compare the TNF-α level of pleural fluid in TB and non-TB pleural effusion. MethodsThe samples in this study that fulfilled the inclusion criteria were patients with non-TB pleural tuberculosis effusion in the inpatient ward in Pulmonology Unit Dr. Soetomo General Hospital Surabaya, male and female, aged between 15 and 60 years. The data is divided into two: primary data and secondary data of patients who fulfilled inclusion and exclusion criteria. The data with normal distribution was analyzed using independent t2 test and if the data distribution is abnormal, it was analyzed using Fisher's exact test. ResultsThere were 22 subjects divided into 2 groups that were 11 patients with TB pleural effusion and 11 patients with non-TB pleural effusion. The TNF-α level of pleural fluid in TB pleural effusion was 25.43±13.55pg/mL. The TNF-α level of pleural fluid in non-TB was 5.98±1.89pg/mL. The serum TNF-α level in TB pleural effusion was 83.22±88.15pg/mL. The serum TNF-α level in non-TB was 68.54±57.88pg/mL. There was higher level of TNF-α pleural fluid in TB pleural effusion than in non-TB pleural effusion (25.43±13.55pg/mL vs 5.98±1.89pg/mL, p value <0.05). The serum TNF-α level in patients with TB pleural effusion was higher than TNF-α serum level of non-TB pleural effusion. There was no significant difference between TNF-α level of pleural fluid and serum TNF-α levels in the TB pleural effusion group (p value >0.05). ConclusionThe TNF-α level of pleural fluid in TB pleural effusion was higher than non-TB pleural effusions and there was no significant difference between serum TNF-α levels in the TB pleural effusion group and in the non-TB pleural effusion group.

Calpain and spectrin breakdown products as potential biomarkers in tuberculous pleural effusion.

Early diagnosis of tuberculous pleural effusion (TPE) remains difficult. Calpain is a family of calcium-dependent endopeptidase that plays an important role in extracellular matrix (ECM) remodeling and collagen synthesis. The aim of this study was to explore the diagnostic value of pleural fluid angiotensin-converting enzyme (ACE), calpain-1, spectrin breakdown products (SBDP), and matrix metalloproteinase-1 (MMP-1) in TPE and malignant pleural effusion (MPE). The study included 47 patients with TPE, 28 patients with MPE, and 10 patients with transudate of non-tuberculous and non-malignant origin as controls. Calpain-1, ACE, SBDP, and MMP-1 levels in pleural fluid were measured by the ELISA method. ACE, calpain-1, SBDP, and MMP-1 levels were higher in TPE than MPE and transudate (all, P<0.05). On multivariate logistic regression analysis, adenosine deaminase (ADA) ≥40 IU/mL, calpain-1 ≥787 ng/mL, and SBDP ≥2.745 ng/mL were independent factors associated with TPE. The predicted probability of TPE based on these three predictors had an area under the receiver operating characteristic (ROC) curve of 0.985, with 97.9% sensitivity and 86.6% specificity under a cut-off value of 0.326. In patients with TPE, residual pulmonary thickening (RPT) was associated with significantly higher calpain-1, SBDP, and MMP-1 levels (all, P<0.05) versus cases without RPT. Our results suggest that the overproduction of calpain-1 and SBDP is associated with pleural fibrosis in tuberculous pleurisy. While ADA is a conventional marker for diagnostic TPE, the simultaneous measurement of calpain-1 and SBDP l in pleural fluid may improve the diagnostic efficacy.

Vascular endothelial growth factor in pleural effusions and correlation with radiologic and biochemical parameters.

Pleural effusion is a common clinical problem with management difficulties. The aim of this study is to evaluate vascular endothelial growth factor (VEGF) in differential diagnosis of pleural effusions and the presence of correlation between radiological features and biochemical properties. The study included patients with pleural effusion. VEGF levels in the pleural fluid were measured by enzyme-linked immunosorbent assay. A total of 97 patients who had exudative pleural effusion related to lung cancer (n = 17), nonpulmonary malignancies (n = 25), mesothelioma (n = 9), pneumonia (n = 14), tuberculosis (n = 8), miscellaneous causes (n = 6), and transudative effusion (n = 18) were included. Pleural VEGF levels were higher in exudative effusions with respect to transudative effusions (P < 0.001) and in effusions related to malignancies versus benign causes (P < 0.001). Pleural VEGF was inversely correlated with pleural fluid glucose and pH levels and had positive correlation with lactate dehydrogenase, protein levels (P < 0.001), hematocrit, and eosinophil values in the pleura (P < 0.05). Pleural VEGF levels were also higher in patients with massive effusions and pleural thickening (both P < 0.001). The overlap of pleural VEGF levels between the groups may limit the value of VEGF in discriminating between malignant versus benign and exudative versus transudative effusions; however, it may be a useful adjunct to various methods. The VEGF levels in pleural fluid seem to be related to the degree of inflammation and pleural invasion.

CXCR3 ligands in pleural fluid as markers for the diagnosis of tuberculous pleural effusion.

A tertiary care academic medical centre. To evaluate the clinical usefulness of C-X-C motif chemokine receptor 3 (CXCR3) ligands in tuberculous pleural effusion (TPE). We recruited 336 patients with pleural effusion due to various causes. Concentrations of interferon-gamma (IFN-γ) and the CXCR3 ligands CXCL9 and CXCL11 were determined using enzyme immunoassays; adenosine deaminase (ADA) activity was measured in pleural fluid and serum. TPE was diagnosed in 106 patients. Non-TB conditions included lung cancer (n = 95), para-pneumonic effusion (n = 52), non-lung malignancy (n = 30), other exudate (n = 24) and transudate (n = 29) disorders. All marker levels in serum samples and pleural fluid were significantly higher in the TPE group. Analyses of receiver operating characteristic curves for differentiating TPE from non-TB effusions produced the following results for the area under the curve (AUC) for CXCL9, CXCL11, IFN-γ and ADA, respectively: 0.982, 0.952, 0.982, and 0.952. Marker AUCs in lymphocytic exudates were also high. Combining the levels of CXCL9, IFN-γ and ADA in pleural fluid improved the diagnostic performance. Serum levels of CXCL9 had the highest AUC (0.848) for diagnosing TPE. Levels of CXR3 ligands in pleural effusion are useful for diagnosing TPE.

Calpain and Spectrin Breakdown Products (SBDP) as Potential Biomarkers in Tuberculous Pleural Effusion

SESSION TITLE: Tuberculosis SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Early diagnosis of tuberculous pleural effusion remains difficult. Calpain is a family of calcium-dependent endopeptidase that plays an important role in ECM remodeling and collagen synthesis. The aim of this study was to explore the diagnostic value of pleural fluid angiotensin-converting enzyme (ACE), Calpain-1, Spectrin breakdown products (SBDP) and matrix metalloproteinase-1 (MMP-1) measurement in tuberculous pleural effusion (TPE) and malignant pleural effusion (MP). METHODS: The study included 47 patients with TP, 28 patients with MP and 10 patients with transudate of non-tuberculous and non-malignant origin as controls. Calpain, ACE, SBDP and MMP-1 levels in pleural fluid were measured by ELISA method. RESULTS: ACE level, Calpain-1 level, SBDP level and MMP-1 level were higher in TPE than MPE and transudate (all, P value<0.05). By logistic regression analysis, ACE > 47.16 ng/mL, Calpain-1> 787 ng/mL, SBDP > 2.745 ng/mL and MMP-1 >7229 pg/mL were independent factors associated with TPE. The predicted probability based on the four predictors had an area under the ROC curve of 0.935, with 89.3% sensitivity and 89.4% specificity under the cut-off value 0.429. CONCLUSIONS: Our data suggest that ACE, Calpain-1, SBDP and MMP-1 levels could be useful biomarkers for diagnosing TPE. CLINICAL IMPLICATIONS: Early diagnpsos of tuberculous pleural effusion remains difficult. Measuring pleural effusion ACE, Calpain-1, SBDP and MMP-1 levels can improve the diagnosis and may give information about pleural fibrosis. DISCLOSURE: The following authors have nothing to disclose: Ji Young Hong, Myung Goo Lee, Chang Youl Lee No Product/Research Disclosure Information

Postmortem evaluation of cholesterol, triglyceride, and apolipoprotein levels.

Cholesterol and triglyceride levels have been analyzed in the forensic setting and their values correlated with atherosclerotic lesions found at autopsy and histology. Nevertheless, the results of these investigations have provided diverging information on postmortem molecule stability and postmortem measurement reliability. The aim of this study was to determine triglycerides, total cholesterol, low-density and high-density lipoprotein cholesterol, apolipoprotein B100, and apolipoprotein A-I in antemortem and postmortem serum samples in a series of cases (N=10, including cardiac and noncardiac deaths) that underwent forensic investigations and had both samples available, measure the same molecules in postmortem serum from femoral blood and pericardial and pleural fluids (N=39, including cardiac and noncardiac deaths), and evaluate whether different levels of these molecules could be observed in cases characterized by different degrees of coronary artery atherosclerosis (N=39, including cardiac and noncardiac deaths). Preliminary results indicated that total cholesterol and low-density and high-density lipoprotein cholesterol levels in postmortem serum samples tended to be lower than those in antemortem specimens, whereas triglyceride levels in postmortem serum samples tended to be higher than those in antemortem samples. No relationship could be found between postmortem serum and pericardial fluid levels or between postmortem serum and pleural fluid levels of all tested biomarkers. Lastly, cases characterized by severe coronary artery atherosclerosis revealed higher postmortem serum levels of total cholesterol and apolipoprotein B. Globally considered, these data confirm that femoral blood postmortem serum levels of cholesterol and apolipoproteins may be considered suitable to estimate their antemortem values in forensic cases characterized by coronary artery atherosclerosis.

Utility of CEA and CA 15-3 Measurements in Non-Purulent Pleural Exudates in the Diagnosis of Malignancy: A Single-Center Experience

ObjectiveTo establish the diagnostic accuracy of pleural fluid (PF) CEA and CA 15-3 in identifying malignancy, and to determine the additional value of these markers in patients with malignant pleural effusions (MPEs) with false negative results from cytological fluid examination. MethodsPF concentrations of CEA and/or CA 15-3 were determined in 1575 patients with non-purulent exudates, 549 of whom had confirmed MPEs, 284 probable MPEs, and 742 benign effusions. Tumor marker cut-off points were set to ensure 100% specificity for malignant effusion. ResultsThe 41%, 40% and 60% of MPE patients had high PF levels of CEA (>45ng/mL), CA 15-3 (>77UI/l) or both, respectively. These percentages were 30%, 19% and 41% in MPEs with positive pleural biopsy and negative PF cytology; and 24%, 13% and 35% in clinical MPEs without histocytological confirmation. Tumor markers were of no value in lymphomas and mesotheliomas. The area-under-the-curve for CEA was 0.819 (95% CI: 0.793–0.845) and for CA 15-3, it was 0.822 (95% CI: 0.796–0.847). The use of tumor markers compared to cytology alone, increased the diagnosis of malignancy by 14%. ConclusionsMeasurements of PF CEA and CA 15-3 may complement pleural cytology in the identification of MPEs.

Proteome profiling reveals novel biomarkers to identify complicated parapneumonic effusions

Patients with pneumonia and parapneumonic effusion (PPE) have elevated mortality and a poor prognosis. The aim of this study was to discover novel biomarkers to help distinguish between uncomplicated PPE (UPPE) and complicated PPE (CPPE). Using an iTRAQ-based quantitative proteomics, we identified 766 proteins in pleural effusions from PPE patients. In total, 45 of these proteins were quantified as upregulated proteins in CPPE. Four novel upregulated candidates (BPI, NGAL, AZU1, and calprotectin) were selected and further verified using enzyme-linked immunosorbent assays (ELISAs) on 220 patients with pleural effusions due to different causes. The pleural fluid levels of BPI, NGAL, AZU1, and calprotectin were significantly elevated in patients with CPPE. Among these four biomarkers, BPI had the best diagnostic value for CPPE, with an AUC value of 0.966, a sensitivity of 97%, and a specificity of 91.4%. A logistic regression analysis demonstrated a strong association between BPI levels > 10 ng/ml and CPPE (odds ratio = 341.3). Furthermore, the combination of pleural fluid BPI levels with LDH levels improved the sensitivity and specificity to 100% and 91.4%, respectively. Thus, our findings provided a comprehensive effusion proteome data set for PPE biomarker discovery and revealed novel biomarkers for the diagnosis of CPPE.

129P - Procathepsin D as a novel diagnostic marker for malignant pleural effusion of lung cancer

Background: Approximately 20% of pleural effusions are due to malignancy, and 50% of these are due to primary lung cancer. However, the etiology of the effusions is often obscure and various diagnostic procedures may be required in order to find their cause. Cathepsin D (CD) as a lysosomal aspartic protease is one of the most important intracellular enzymes considered to be substantially involved in tumor invasion. Procathespin D (pCD) is overexpressed and secreted by cells of various tumor types. The aim of this study is to evaluate the serum and pleural fluid levels of CD and pCD as a differential diagnostic tool in patients with pleural effusion caused by malignant or benign process. Methods: Patients and pleural fluid collection: The present study included 85 patients (40 patients with lung cancer, 30 patients with tuberculosis, 10 patients with parapneumonic effusion, 5 patients with transudate effusion) who underwent thoracentesis and pleural biopsy. Clinical and pathology data, including tumor type were acquired for all patients. Analysis of CD and pCD: Amounts of CD in the pleural fluid and serum were determined with a cathepsin D ELISA kit and pCD with a sandwich ELISA method. Results: Concentration of pleural CD was not significantly different in patients with malignant pleural effusion compared with non malignant effusion (mean 13.34 vs. 16.72 ng/ml; p > 0.05), and also the concentration of serum CD was not significantly different (mean 41.34 vs. 36.52 ng/ml; p > 0.05). Plasma pCD of malignant pleural effusion and non malignant effusion were 42.03 ng/ml and 38.59 ng/ml, respectively (p > 0.05) but pleural pCD of malignant pleural effusion and non malignant effusion were 84.24 ng/ml and 33.82 ng/ml, respectively with significance (p < 0.05). Conclusions: In this small cohort, the pleural pCD of lung cancer patients showed elevated levels compared with that of non malignant effusion. The pleural fluid levels of pCD could be a diagnostic marker of malignant effusion with lung cancer and further prospective studies might shed more light on the value of CD and pCD in the diagnostics of pleural effusion. Legal entity responsible for the study: Chang Youl Lee Funding: Hallym University Medical Center Disclosure: All authors have declared no conflicts of interest.

Utilidad de la medición de CEA y CA 15-3 en los exudados pleurales no purulentos para diagnosticar malignidad: experiencia de un único centro

ObjectiveTo establish the diagnostic accuracy of pleural fluid (PF) CEA and CA 15-3 in identifying malignancy, and to determine the additional value of these markers in patients with malignant pleural effusions (MPEs) with false negative results from cytological fluid examination. MethodsPF concentrations of CEA and/or CA 15-3 were determined in 1,575 patients with non-purulent exudates, 549 of whom had confirmed MPEs, 284 probable MPEs, and 742 benign effusions. Tumor marker cut-off points were set to ensure 100% specificity for malignant effusion. ResultsThe 41, 40 and 60% of MPE patients had high PF levels of CEA (>45ng/mL), CA 15-3 (>77 UI/l) or both, respectively. These percentages were 30, 19 and 41% in MPEs with positive pleural biopsy and negative PF cytology; and 24, 13 and 35% in clinical MPEs without histocytological confirmation. Tumor markers were of no value in lymphomas and mesotheliomas. The area-under-the-curve for CEA was 0.819 (95% CI: 0,793-0,845) and for CA 15-3, it was 0.822 (95% CI: 0,796-0,847). The use of tumor markers compared to cytology alone, increased the diagnosis of malignancy by 14%. ConclusionsMeasurements of PF CEA and CA 15-3 may complement pleural cytology in the identification of MPEs.

The prognostic value of carcinoembryonic antigen levels in blood and intraoperative pleural lavage fluid in non-small-cell lung cancer.

IntroductionThere is no specific marker for lung cancer, but, in some lung cancer types, carcinoembryonic antigen (CEA) can reach high levels in the blood and pleural fluid.AimThis study investigated the relationship of CEA levels in blood (CEAB) and intraoperative pleural lavage fluid (CEAP) in non-small-cell lung cancer (NSCLC) with the type, stage, and extent of lung cancer.Material and methodsA total of 50 patients, who underwent surgery at our clinic due to NSCLC (group I) or benign lung pathology (group II), were assessed. For this prospectively designed study, 25 consecutive patients were included in each group, and their CEAB and CEAP levels were investigated.ResultsWhen the levels of CEAP were compared, the average value of group I (1.35 ng/ml) was significantly higher than the average value of group II (0.04 ng/ml) (p = 0.027). When CEA levels were examined separately, and average values were taken according to surgical pathology results, both CEAB and CEAP levels of adenocarcinoma patients were found to be higher than those of the other groups. This difference was only significant for the level of CEAP (p = 0.026).ConclusionsAlthough the average CEAB levels of patients with adenocarcinoma were higher than those of patients with other histopathological types, this difference was not statistically significant. However, we found that CEAP levels were significantly higher in patients with adenocarcinoma. These results have led us to consider that CEAP elevation is a more sensitive marker than the elevation of CEAB.

The importance of serum and pleural fluid level of vascular endothelial growth factor (VEGF) and VEGF fluid/serum ratio in the differential diagnosis of malignant mesothelioma-related pleural effusion.

Aim of the studyVascular endothelial growth factor (VEGF) is one of the parameters that has been studied in differential diagnosis of malignant fluids. This study is aimed at evaluate applicability of serum, fluid VEGF level and fluid to serum VEGF ratio in the diagnosis of malignant pleural mesothelioma (MPM).Material and methodsThe patients with pleural effusion over age of 18, between 2011 and 2015 were included in the study. They were divided into three groups: group 1 – mesothelioma patients; group 2 – other malignancies; and group 3 – benign aetiologies. Group 1 and 2 were termed as the malignant group. Fluid, serum VEGF levels, and the ratio of fluid/serum VEGF level were studied to evaluate the fluid/serum VEGF ratio in all groups.ResultsTwenty cases with mesothelioma, 44 cases with other malignancies, and 20 cases with benign aetiologies were included in this study. No statistically significant difference was found according to serum VEGF levels for all groups, (group 1: 437 ±324 pg/ml, group 2: 354 ±223 pg/ml, group 3: 373 ±217 pg/ml, p = 0.836), while fluid VEGF levels showed a statistically significant difference (group 1: 3359 ±700 pg/ml, group 2: 2175 ±435 pg/ml, group 3: 1092 ±435 pg/ml, p = 0.041). The ratio of fluid to serum VEGF levels showed a difference, at the significance limit, between the malignant (group 1 and group 2) and benign (group 3) groups (8.83 ±1.29 vs. 4.57 ±1.07, p = 0.059) but showed a statistically significant difference between the mesothelioma and benign groups (12.11 ±1.68 vs. 4.57 ±1.07, p = 0.044).ConclusionsThe VEGF fluid/serum ratio may be an applicable parameter in the differential diagnosis of malignant fluids, especially MPM.

Vascular endothelial growth factor in diagnosis of pleural effusion

BackgroundVascular endothelial growth factor (VEGF) is a glycoprotein which is an important mediator of angiogenesis and vascular permeability. Different VEGF levels were found in carcinomatous, inflammatory and tuberculous pleural effusions, implying a varying degree of influence on the process of fluid accumulation in the pleural space in different disease states. Aim of the work: to assess the role of serum and pleural fluid VEGF levels to evaluate its value as a marker in diagnosis of pleural effusion of different etiologies. MethodsForty patients with pleural effusion, 19 males and 21 females, with a mean age of 55.960±6.835years, were classified into transudative and exudative groups. All patients were subjected to thorough history, clinical examination, radiological examination, laboratory investigations, sputum for acid fast bacilli, tuberculin test, thoracocentesis and occasionally pleural biopsy or thoracoscopy and both serum and pleural fluid VEGF were measured in all patients. ResultsThere was a significant difference between exudate and transudate regarding serum and pleural fluid VEGF levels that were higher in exudates than transudate. In comparison between the subtypes of exudative effusion, there was higher concentration of VEGF in pleural of malignant than tuberculous, parapneumonic, and collagen exudative effusion. ConclusionVEGF pleural fluid level could differentiate between malignant and non malignant effusion, while could not differentiate between tuberculous and nontuberculous, or between parapneumonic and nonparapneumonic exudative effusions.

Comparison of the diagnostic utility of ADA and CA125 in tuberculous effusion

BackgroundPleural effusion can be due to various pleural infections like TB as well as neoplasia. CA125 is a tumor marker found on the surface of ovarian and other normal cells as pleural cells. CA125 has been found to increase in serum and hence pleural fluid of patients with pleural effusion due to malignancy as well as due to TB.This study was conducted to evaluate the utility of CA125 in the diagnosis of pleural effusion resulting from TB, malignancy and pneumonia as well as to evaluate and compare the diagnostic utility of CA125 and ADA in the diagnosis of TB effusion. Patients and methods20 patients with tuberculous effusion (group I), 20 patients with malignant effusion (group II) and 20 patients with parapneumonic effusions (group III) were evaluated for the levels of CA125 and ADA in their pleural fluid. In malignant cases, diagnosis was made through microscopic inspection of pleural biopsy samples and cytology of pleural fluid. For diagnosis of tuberculosis, Ziehl Neelsen sputum smear, pleural fluid smear and/ or culture. Parapneumonic effusions were confirmed by pleural fluid cell count and culture & sensitivity. ResultsThe mean±SD level of CA125 in pleural fluid was 41.732±20.744U/ml, 309.27±79.564U/ml and 7.040±5.601U/ml in tuberculous, malignant and parapneumonic effusions respectively; which showed a statistically significant difference between the three groups (p<0.01). Pleural fluid CA125 was significantly higher in group II than group I (P1=0.000), and group III (P3=0.000). Pleural fluid CA125 was significantly higher in group I than group III (P2=0.000). Pleural fluid ADA was significantly higher in group I than group II (P1=0.000) and group III (P2=0.000). For diagnosing TB, CA125 showed a sensitivity and specificity of 74.1%, 76.9%, respectively while ADA demonstrated a sensitivity and specificity of 75% and 75% respectively. ConclusionCA-125 levels in pleural fluid may be used for differentiation between TB, pneumonic, and malignancy-induced effusions.Also CA125 may be added to the diagnostic workup of pleural fluid for accurate diagnosis of TB effusion.

Diagnostic and Prognostic Biomarkers in the Rational Assessment of Mesothelioma (DIAPHRAGM) study: protocol of a prospective, multicentre, observational study

IntroductionMalignant pleural mesothelioma (MPM) is an asbestos-related cancer, which is difficult to diagnose. Thoracoscopy is frequently required but is not widely available. An accurate, non-invasive diagnostic biomarker would allow early...

A potential role for VEGF in the diagnostic approach of pleural effusions.

Vascular endothelial growth factor (VEGF) may play a role in pleural fluid formation, as it represents a potent inducer of capillary permeability. We aimed to investigate the diagnostic utility of VEGF levels in pleural fluid and serum in patients with pleural effusions with initially negative diagnostic work up. Seventy-one patients with exudative lymphocytic pleural effusions undiagnosed after initial diagnostic work up were enrolled in this prospective study and their clinical course was followed up to 24 months. VEGF levels were measured in serum and pleural fluid by using immunoenzymometric assay. During the follow up period, in 43 patients the pleural effusion was eventually attributed to malignancy while in the rest 28 patients it was due to non-malignant causes (benign and unknown origin). Patients with malignancy had significantly higher VEGF levels in pleural fluid compared to patients with non-malignant effusions (1,506 vs. 588 pg/dL, P=0.0001), while no statistically significant difference was found in the VEGF serum levels between the two groups. Pleural VEGF levels may be helpful in identifying malignant pleural effusion (MPE) in patients with negative diagnostic work up at the initial assessment and help in selecting patients for more invasive procedures.