scholarly journals A Retrospective Study of Ultrasound Characteristics and Macroscopic Findings in Confirmed Malignant Pleural Effusion

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Nevenka Piskac Zivkovic ◽  
Igor Cikara ◽  
Nina Petra Novak ◽  
Boris Brkljacic ◽  
Neven Tudoric
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Diagnostic Significance ◽  
Macroscopic Appearance ◽  
Frequency Distributions ◽  
Thoracic Ultrasound ◽  
Pleural Thickening ◽  
Diagnostic Potential ◽  
Number Of Patients ◽  
Significant Difference

Background. A definitive diagnosis of malignant pleural effusion (MPE) is reached by cytological or histological assessment, but thorough analysis of the ultrasound features of the effusion as well as pleural thickening or nodularity can also be of significant diagnostic help. Objective. To assess the relationship of specific ultrasound characterisctics and macroscopic features of confirmed malignant pleural effusion, thus increasing the diagnostic potential of thoracic ultrasound. Methods. The findings of thoracic ultrasonography performed prior to initial thoracentesis in 104 patients with subsequently confirmed malignant pleural effusion were analyzed with regard to the macroscopic features of the pleural effusion. Results. Distribution in terms of frequency of hemorrhagic/sanguinolent (n=64) in relation to nonhemorrhagic transparent/opaque (n=40) MPE, regardless of their ultrasound characteristics, did not yield a statistically significant correlation (p=0.159). Conversely, the frequency distribution of hemorrhagic pleural effusions (n=8) in relation to nonhemorrhagic effusions (n=1), in the group of septated MPE, showed a statistically significant difference (p<0.001). The least number of patients (0.96%) had a complex septated MPE combined with the macroscopic appearance of a serous/transparent nonhemorrhagic effusion, which suggests that this combination is a sporadic occurrence and may have a diagnostic significance for this patient group. Conclusion. The incidence of specific combinations of the ultrasound characteristics and macroscopic appearance of MPEs showed different frequency distributions, which may improve the diagnostic value of thoracic ultrasound in this patient population.

Diagnostic Potential of Carcinoembryonic Antigen and Ferritine in Tuberculous and Malignant Pleural Effusion

1995 ◽  
Vol 81 (6) ◽  
pp. 440-444 ◽  
Author(s):  
Robert Loncar ◽  
Ljerka Ostojic ◽  
Vera Tabakovic-Loncar ◽  
Ante Roguljić
Keyword(s):  
Pleural Effusion ◽  
Carcinoembryonic Antigen ◽  
Sensitivity And Specificity ◽  
Malignant Pleural Effusion ◽  
Bayes Theorem ◽  
Diagnostic Value ◽  
Physical Status ◽  
Predictive Values ◽  
Diagnostic Potential ◽  
Significant Difference

The aim of the study was to determine the diagnostic value of carcinoembryonic antigen (CEA) and ferritine in malignant and tuberculous non-bloody pleural effusion. The etiology of diseases was determined by cytologic, histologic and microbiologic methods. CEA concentration above 5 ng/ml and ferritine concentration above 200 ng/ml were considered to be positive. There was significant difference in the value of CEA measured in malignant and in tuberculous pleural effusion (P < 0.005) as well as in the sera (P < 0.01) of these two groups. There was no correlation between concentration of CEA and ferritine in malignant pleural effusion. Ratio between CEA and ferritine in effusions and sera was of no help in discrminating malignant from tuberculous effusions. No correlation between examined markers and physical status of patients was observed. The sensitivity and specificity of CEA assay in malignant pleural effusion was 65% and 90%, respectively, and for ferritine 67% and 80%, respectively. A high correlation was observed between the CEA concentration in malignant pleural effusion and sera patients (r = 0.95). Combined sensitivity and specificity of CEA and ferritine was 65.9% and 85%. Bayes theorem was used to calculate the positive predictive values for CEA and ferritine, which were 53% and 37%, respectively. Results obtained in the study show the relatively good diagnostic potential of CEA.

Management of malignant pleural effusion. A retrospective study comparing efficiency and outcomes of VATS talcum pleurodesis, insertion of tunneled pleural catheter (PleurX®), and a combination of both

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
L F Azenha Figueiredo ◽  
S Deckarm ◽  
G Kocher
Keyword(s):  
Pleural Effusion ◽  
Length Of Stay ◽  
Malignant Pleural Effusion ◽  
Treatment Strategies ◽  
Secondary Outcome ◽  
Oncological Disease ◽  
Day Range ◽  
Significant Difference ◽  
Pleural Catheter ◽  
Talcum Pleurodesis

Abstract Objective The management of malignant pleural effusion is a common problem in thoracic surgery. Patients are often polymorbid and are usually referred at a terminal stage of their oncological disease. Our objective was to compare the efficiency and outcomes after different treatment strategies of malignant pleural effusion. Methods We retrospectively reviewed the charts of a total of 416 patients treated during the period of 2010 to 2020 who underwent thoracoscopic pleurodesis with or without implantation of tunneled pleural catheter (TPC) as well as patients who underwent the implantation of TPC alone. Primary outcome was postoperative survival and secondary outcome was length of stay (LOS). In addition, we documented the recurrence of ipsilateral pleural effusion and the need for reintervention as well as the pulmonary reexpansion of the lung on postoperative chest x-ray. Inclusion criteria were malignant pleural effusion and documented follow-up until time of death. Exclusion criteria were treatment for mesothelioma, pneumothorax and emphysema. Results A total of 199 patients were included for analysis. Median LOS of patients treated with implantation of TPC alone in analgosedation (n = 28) was 1 day (range:1-4 days). Median LOS of patients who received video-assisted talcum pleurodesis (n = 65) without implantation of a TPC was 6 days (range 1-38 days). Median LOS of patients who received VATS talcum pleurodesis and TPC (n = 106) was 3 days (range 1-34 day). The difference in LOS was statistically significant (p &lt; 0.05). Median overall survival was 108 days (range 3-3001 days). There was no statistically significant difference in survival between the different treatment groups (p = 0.47). Conclusion The primary goal when treating patients with malignant pleural effusion is relief of dyspnea and/or pain and to keep the duration of the inpatient treatment to a minimum. In patients with a considerable surgical risk due to comorbidities and their underlying oncological disease and who don’t require the sampling of histological material, a conservative treatment option with implantation of a TPC can be sufficient. The additional insertion of a TPC not only reduces the length of stay, but also has a positive effect on the efficacy of the pleurodesis in terms of less recurrence. We therefore recommend the routine use of TPC when performing VATS talcum pleurodesis in patients with malignant pleural effusion.

scholarly journals PAI-1 Level Differences in Malignant Plural Effusion, Parapneumonic Pleuritis, and Cardiac Hydrothorax

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 567
Author(s):  
Zentina ◽  
Stukena ◽  
Krams ◽  
Lejnieks
Keyword(s):  
Pleural Effusion ◽  
Fibrinolytic Activity ◽  
Malignant Pleural Effusion ◽  
Clinical Manifestations ◽  
Plasminogen Activator Inhibitor ◽  
Pleural Effusions ◽  
Plasminogen Activator Inhibitor 1 ◽  
Significant Difference ◽  
Activator Inhibitor ◽  
Pai 1

Background and Objectives: Plasminogen activator inhibitor-1 (PAI-1) is a fibrinolytic system enzyme whose role in various fibrinolytic processes is currently unknown. In clinical manifestations of pleural liquids of diverse etiology, various levels of fibrinolytic activity can be observed—parapneumonic processes tend to loculate in fibrin septa, while malignant pleural effusion (MPE) does not. The purpose of this study was to determine possible differences in PAI-1 levels in pleural effusions of varied etiology. Material and Methods: PAI-1 level in pleural effusion and serum was determined in 144 patients with pleural effusions of various etiology (cardiac hydrothorax—42 patients (29.2%), MPE—67 patients (46.5%), parapneumonic pleuritis—27 (18.8%), tuberculous pleuritis—6 patients (4.1%), pancreatogenic pleuritis—1 patient (0.7%) and pulmonary artery thromboembolism with pleuritis—1 patient (0.7%)). Results: The median PAI-1 level (ng/mL) was the highest in the parapneumonic pleuritis group both in the effusion and the serum, with values of 291 (213–499) ng/mL and 204 (151–412) ng/mL, respectively, resulting in a statistically significant difference (p < 0.001) from the cardiac hydrothorax and MPE groups. However, there was no statistically significant difference between PAI-1 levels in the pleural effusion and serum in the cardiac hydrothorax and MPE groups. Conclusion: The PAI-1 level in MPE and cardiac hydrothorax was statistically significantly lower than in parapneumonic pleuritis.

Suspicious for Malignancy Diagnoses on Pleural Effusion Cytology

2020 ◽  
Vol 154 (3) ◽  
pp. 394-402
Author(s):  
Erika F Rodriguez ◽  
Ricardo G Pastorello ◽  
Paul Morris ◽  
Mauro Saieg ◽  
Sayanan Chowsilpa ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Sample Volume ◽  
Definitive Diagnosis ◽  
Cell Tumor ◽  
Pleural Effusions ◽  
Not Otherwise Specified ◽  
Significant Difference ◽  
Pathology Reports ◽  
Average Sample

Abstract Objectives A definitive diagnosis of malignancy may not be possible in pleural effusions. We report our experience with the diagnosis of suspicious for malignancy (SFM) in pleural effusion. Methods A search for pleural effusions diagnosed as SFM (2008-2018) was performed. Patient records and pathology reports were reviewed. Specimens were subdivided into groups depending on volume (&lt;75, 75-400, &gt;400 mL). Diagnoses of malignant pleural effusion (MPE) served as controls. Results We identified 90 patients, with a mean age of 60.6 years. Diagnoses included suspicious for involvement by carcinoma/adenocarcinoma in 64.4%, leukemia/lymphoma in 15.6%, melanoma in 2.2%, sarcoma in 3.3%, germ cell tumor in 1.1%, and not otherwise specified in 13.3%. Immunostains were performed in 47.8% and considered inconclusive in 24%. Average sample volume was 419 mL. There was a statistically significant difference between the SFM vs MPE groups for volumes greater than 75 mL (P = .001, χ 2 test), with SFM having increased proportion of volumes  greater than 400 mL, compared with the MPE group. There was no statistically significant difference in mean overall survival when the groups were compared (P = .49). Conclusions Samples with low cellularity, scant cell blocks, and inconclusive immunostains may contribute to a suspicious category diagnosis in pleural effusions.

Thoracic Ultrasound for guiding pleurodesis in malignant pleural effusion: a randomised trial

2021 ◽  
Author(s):  
Maged Hassan ◽  
Ioannis Psallidas ◽  
Ahmed Yousuf ◽  
Tracy Duncan ◽  
Shahul Leyakathali Khan ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Randomised Trial ◽  
Thoracic Ultrasound

scholarly journals Thoracic ultrasound in the diagnosis of malignant pleural effusion

Thorax ◽  
2009 ◽  
Vol 64 (2) ◽  
pp. 139-143 ◽  
Author(s):  
N R Qureshi ◽  
N M Rahman ◽  
F V Gleeson
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Thoracic Ultrasound

scholarly journals Diagnostic significance of pleural fluid adenosine deaminase activity in tuberculous pleurisy

1970 ◽  
Vol 5 (1) ◽  
pp. 1-5
Author(s):  
Sharmeen Ahmed ◽  
Reaz Fatema ◽  
Ahmed Abu Saleh ◽  
Mumayun Sattar ◽  
Md Ruhul Amin Miah
Keyword(s):  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Pleural Fluid ◽  
Colorimetric Method ◽  
Diagnostic Methods ◽  
Test Accuracy ◽  
Diagnostic Significance ◽  
Tuberculous Pleural Effusion ◽  
Adenosine Deaminase Activity ◽  
Significant Difference

Diagnosis of tuberculous pleural effusion (TPE) is difficult because of its non-specific clinical presentation and insufficient efficiency of conventional diagnostic methods. The study was carried out to evaluate the utility of adenosine deaminase (ADA) activity in pleural fluid for the diagnosis of TPE. ADA activity was measured in pleural fluid of 103 pleural effusion patients by colorimetric method using a commercial ADA assay kit. The diagnosis of TPE was made from pleural fluid examinations (including cytology, biochemistry, and bacteriology) and pleural biopsy. Patient with negative result of this methods were diagnosed by response of empirical treatment. Out of 130 cases, 62 (61.1%) had TPE and the remaining 41 (39.8%) had pleural effusion due to non tuberculous diseases. There was statistically significant difference (p < 0.001) between the mean of pleural fluid ADA levels (70.82±22.54 U/L) in TPE group and (30.07±22.93 U/L) in non-TPE group. Of 62 TPE cases, microscopy for AFB and culture for M.tuberculosis in pleural fluid revealed positivity in 9.6% and 22.5% cases respectively, and biopsy of pleura showed typical epithelioid granuloma in only 43.5% cases. The cut-off value of ADA for diagnosing TPE was 40 U/L using a ROC curve, with a sensitivity of 94% and specificity of 88%. Positive and negative predictive value of ADA assay were 92% and 90% respectively. The overall test accuracy was 90%. Pleural fluid ADA assay is therefore a simple, rapid, highly sensitive and specific adjunct test for diagnosis of TPE. DOI: http://dx.doi.org/10.3329/imcj.v5i1.9852   Ibrahim Med. Coll. J. 2011; 5(1): 1-5 Keywords: Pleural fluid; adenosine deaminase; tuberculous pleural effusion

scholarly journals Thoracic Ultrasound as an Early Predictor of Pleurodesis Success in Malignant Pleural Effusion

CHEST Journal ◽  
2018 ◽  
Vol 154 (5) ◽  
pp. 1115-1120 ◽  
Author(s):  
John P. Corcoran ◽  
Robert J. Hallifax ◽  
Rachel M. Mercer ◽  
Ahmed Yousuf ◽  
Rachelle Asciak ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Thoracic Ultrasound ◽  
Early Predictor
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