Diagnostic yield of pleural fluid cell block and fluid cytology in malignant pleural effusion: Study of 200 cases in tertiary care

ABSTRACT Background: Pleural fluid cytology for malignant cells is the easiest way to diagnose malignant pleural effusion with good sensitivity and specificity. With the introduction of medical thoracoscopy, the use of closed pleural biopsy for the diagnosis of cytology negative malignant pleural effusion is gradually decreasing. However use of thoracoscopy is limited due to its high cost and procedure related complications. Aims: The aim was to assess the usefulness of closed pleural biopsy in the diagnosis of malignant pleural effusion. Materials and Methods: Sixty-six patients of pleural effusion associated with malignancy were selected from the patients admitted in the chest ward of a tertiary care hospital over a period of 1 year. Pleural fluid aspiration for cytology and closed pleural biopsy were done in all the patients. Results: Out of 66 patients, 46 (69%) patients showed malignant cells in pleural fluid cytology examination. Cytology was positive in 35 (52%), 10 (15%), and 1 (1.5%) patients in the first, second, and third samples respectively. Closed pleural biopsy was positive in 32 (48%) patients. Among them, 22 also had positive cytology. Additional 10 cytology negative patients were diagnosed by pleural biopsy. Cytology–histology concordance was seen in 12 patients. Definite histological diagnosis could be achieved in five patients with indeterminate cytology. Pleural biopsy was not associated with any major postoperative complication. Conclusion: Closed pleural biopsy can improve the diagnostic ability in cytology negative malignant pleural effusion. Closed pleural biopsy has still a place in evaluation of malignant pleural effusion especially in a resource-limited country like India.

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Diagnostic Value of Flexible Thoracoscopy in Undiagnosed Cases of Exudative Pleural Effusion

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/571 ◽

2020 ◽

Vol 7 (47) ◽

pp. 2783-2786

Author(s):

Vengada Krishnaraj S.P. ◽

Gayathri S. Mohan ◽

Vinod Kumar V ◽

Sridhar R

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Complete Blood Count ◽

Diagnostic Yield ◽

Diagnostic Value ◽

Parietal Pleura ◽

Pleural Biopsy ◽

Cardiac Evaluation ◽

Exudative Pleural Effusion ◽

Fluid Cytology

BACKGROUND The diagnostic yield of thoracoscopy is 95 %, of pleural fluid cytology it is 62 % and of closed pleural biopsy is 44 %, in malignant effusion. We wanted to study the diagnostic utility of flexible thoracoscopy in undiagnosed exudative pleural effusion and compare the thoracoscopy findings with the histopathology results. METHODS The study was conducted in the Department of Respiratory Medicine, Government Stanley Medical College, Chennai, from January 2019 to January 2020. 40 patients were enrolled in this longitudinal observational study with moderate to massive effusion and were evaluated with pleural fluid aspiration and sent for cytology, protein sugar analysis, total count, and ADA. Those cases which are exudative pleural effusions, with ADA value of less than 40 IU / L were subjected to thoracoscopy after being evaluated for fitness for thoracoscopy with complete blood count, bleeding time, clotting time, sputum for AFB, ECG, pulse oximetry, cardiac evaluation and CT chest. RESULTS Thoracoscopy was done in 40 enrolled patients. In this study, biopsy was taken from the parietal pleura in all the cases. Of these 40 cases, 30 were male and 10 were female, that is 75 % males and 25 % females. The mean age of the study population was 43 ± 14.9. Patient with the lowest age in this study group was 18 years and highest was 71 years. 16 cases (40 %) presented with left sided pleural effusion. 24 cases (60 %) presented with right sided pleural effusion. 30 cases presented with massive effusion, and 10 cases with moderate effusion. Of the 40 cases, 27 cases presented with straw coloured pleural effusion. 13 cases were haemorrhagic effusion. Histopathologic examination showed 11 cases as malignant and 29 cases as non-malignant out of which 18 cases were of tuberculosis aetiology. Thoracoscopy revealed adhesions in 13 cases and mass lesion in 4 cases. Of the 4 mass lesions 3 came as malignant, normal pleura in 11 cases, 10 were non-malignant and 1 was malignant. Nodules were seen in 12 cases of which 7 came as malignant. Straw coloured effusion was seen in 27 cases, of which 2 were malignant. CONCLUSIONS The most important indication for thoracoscopy is exudative undiagnosed pleural effusion. The overall diagnostic yield in pleural fluid cytology is 62 % and blind pleural biopsy is 44 %. The diagnostic yield of thoracoscopy varies from 60 % to 97 % in various studies, whereas, in our study, it is 72.5 %. Visualization of the visceral and parietal pleura is another advantage, so that we can take biopsy from the abnormal areas. KEYWORDS Flexible Thoracoscopy, Undiagnosed Exudative Pleural Effusion

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Diagnosis of Malignant Pleural Effusion Using CT Scan and Pleural-Fluid Cytology Together. A Preliminary Case–Control Study

Anticancer Research ◽

10.21873/anticanres.14054 ◽

2020 ◽

Vol 40 (2) ◽

pp. 1135-1139 ◽

Cited By ~ 1

Author(s):

STEFANO M.M. BASSO ◽

FRANCO LUMACHI ◽

ALESSANDRO DEL CONTE ◽

SANDRO SULFARO ◽

FEDERICA MAFFEIS ◽

...

Keyword(s):

Pleural Effusion ◽

Ct Scan ◽

Pleural Fluid ◽

Malignant Pleural Effusion ◽

Case Control Study ◽

Case Control ◽

Control Study ◽

Fluid Cytology

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CYTO-DIAGNOSIS OF PLEURAL EFFUSIONS: A COMBINED APPROACH TO MORPHOLOGICAL FEATURES IN ROUTINELY STAINED CYTOLOGY SMEARS AND CELL BLOCK TECHNIQUE

10.36106/ijsr/5831349 ◽

2021 ◽

pp. 3-5

Author(s):

Lubna Khan ◽

Mahendra Singh ◽

Anshul Pratap Singh ◽

Mohd Faheemuddin

Keyword(s):

Pleural Effusion ◽

Diagnostic Yield ◽

Tertiary Care ◽

North India ◽

Parietal Pleura ◽

Cell Block ◽

Pleural Effusions ◽

Tertiary Care Centre ◽

Pathology Department ◽

Smear Examination

Introduction: Pleural cavity is a potential space between the parietal pleura and visceral pleural. It consists of some amount of uid called pleural uid which is normally less than 25ml. Pleural uid is produced by parietal lining and absorbed by visceral lining. Fluid is produced by plasma ltration through capillary endothelial cells. Aims & Objectives:Acombined approach of cytology and cell block technique in diagnosing the cause of pleural effusion. To evaluate the utility of cell block preparation over the conventional smear in the cytodiagnosis of serous effusions. Material & Methods: The present study was conducted on patients having pleural effusions. The cases and specimens were selected from the outdoor as well as indoor patients admitted in a tertiary care centre of North India and also from those sent directly to Pathology department from other hospitals. The duration of study was from January 2019 to September 2020. The specimens obtained were processed in the biochemistry, cytopathology and histopathology laboratory in the Pathology department of GSVM Medical College, Kanpur. Result And Analysis: Out of 100 cases studied it was found that 83 (83%) cases were of reactive pleural effusion and 17 (17%) cases were of malignant pleural effusions.Out of 17 malignant effusion, 16 (94%) cases were exudative, while 1 (6%) case was transudative.Only 8 cases of adenocarcinoma were diagnosed on smear examination, while 11 cases were diagnosed on cell block examination. 3 cases of poorly differentiated carcinoma were diagnosed on conventional smear and 5 cases on cell block examination.Out of total 17 malignant pleural effusions diagnosed by cell block, only 12 cases were diagnosed by conventional smear examination. Hence diagnostic yield increased by 30% using cell block preparations. Conclusion: Thus it was concluded that routine centrifuge is not satisfactory in reporting uids with scant cellularity. Hence for uids with scant cellularity cell block preparation is a useful method. Also the morphology of the cells were well appreciated by cell block as compared to routine centrifuge, thus aiding in accurate diagnosis. In this study the diagnoses which were missed or incompletely diagnosed on conventional smear were diagnosed by cell block.

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Evaluation of Pleural Fluid Cytology for the Diagnosis of Malignant Pleural Effusion: A Retrospective Cohort Study

10.21203/rs.3.rs-112086/v1 ◽

2020 ◽

Author(s):

L Pairman ◽

Lutz E.L. Beckert ◽

Mark Dagger ◽

Michael J Maze

Keyword(s):

Breast Cancer ◽

Cohort Study ◽

Pleural Effusion ◽

Pleural Fluid ◽

Retrospective Cohort ◽

Malignant Pleural Effusion ◽

False Negative ◽

Negative Results ◽

False Negative Results ◽

Fluid Cytology

Abstract BackgroundAs median survival time for patients with malignant pleural effusions (MPE) is nine months, rapid and accurate diagnosis is important. Cytological examination of pleural fluid has a good specificity but imperfect sensitivity. Published estimates of sensitivity vary substantially and predictors of false negative cytology are not well established. We aim to establish a local estimate of pleural fluid cytology sensitivity and identify risk factors for false negative cytology.MethodsWe conducted a retrospective cohort study of patients who had cytology testing of pleural fluid at Christchurch Hospital, New Zealand 21 July 2017 to 31 October 2019. Data on patient demographic, clinical and pleural fluid characteristics were collected. MPE was defined by positive pleural fluid cytology, tissue histology, or multi-disciplinary meeting consensus. We estimated sensitivity of the first pleural cytology assessment. We performed multivariate logistic regression to ascertain patient groups at greatest risk of false negative results. ResultsOf 156 patients with confirmed malignant pleural effusion included in our study, the initial pleural fluid cytology was diagnostic in 117, providing a sensitivity (95% confidence interval) of 75.0% (67.4-81.6%). The sensitivity was 79.0% (66.8-88.3%) for lung cancer, 91.3% (72.0-98.9%) for breast cancer and 33.3% (95% CI 11.8-61.6%) for mesothelioma. Cloudy appearance of pleural fluid (OR 0.17, 95% CI 0.04-0.84), but not pH, lactate dehydrogenase or polynuclear cell ratio, reduced the odds of false negative pleural cytology.ConclusionPleural fluid cytology was sensitive in diagnosing MPE due to primary lung and breast cancer, however it had low sensitivity in mesothelioma. Clinicians should be particularly alert to the high likelihood of false negative results when suspecting mesothelioma and consider early use of biopsy.

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