Diagnostic value of pleural fluid and serum procalcitonin levels in the diagnosis of parapneumonic pleural effusion

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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CEA and ADA in Pleural Fluid for Differential Malignant Pleural Effusion and Tuberculous Pleural Effusion

10.21203/rs.3.rs-757795/v1 ◽

2021 ◽

Author(s):

Jianhong Yu ◽

Qirui Cai

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Roc Curve ◽

Malignant Pleural Effusion ◽

Diagnostic Value ◽

Diagnostic Model ◽

Diagnostic Efficacy ◽

Tuberculous Pleural Effusion ◽

Diagnostic Models ◽

Independent Risk Factors

Abstract Objective This study aimed to establish a predictive model based on the clinical manifestations and laboratory findings in pleural fluid of patients with pleural effusion for the differential diagnosis of malignant pleural effusion (MPE) and tuberculous pleural effusion (TPE). Methods Clinical data and laboratory indices of pleural fluid were collected from patients with malignant pleural effusion and tuberculous pleural effusion in Zigong First People's Hospital between January 2019 and June 2020，and were compared between the two groups. Independent risk factors or Independent protective factors for malignant pleural effusion were investigated using multivariable logistic regression analysis. Receiver operating characteristic curve (ROC) analysis was performed to assess the diagnostic performance of factors with independent effects, and combined diagnostic models were established based on two or more factors with independence effect. ROC curve was used to evaluate the diagnostic ability of each model, and the fit of the eath model was measured using Hosmer-Lemeshow goodness-of-fit test. Results Patients with MPE were older than those with TPE, the rate of fever of patients with MPE was lower than that of patients with TPE, and these differences were statistically significant (p < 0.05). Carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin-19 fragment antigen (CYFRA21-1), cancer antigen 125 (CA125), and glucose (GLU) levels in the pleural fluid were higher, but total protein (TP), albumin (ALB) and Adenosine deaminase (ADA) levels in the pleural fluid were lower in MPE patients than in TPE patients, and the differences were statistically significant (P<0.05). In multivariate logistic regression analysis, CEA and NSE levels in the pleural fluid were independent risk factors for MPE, whereas ADA levels in pleural fluid and fever were independent protective factors for MPE. The differential diagnostic value of pleural fluid CEA and pleural fluid ADA for MPE and TPE were higher than that of pleural fluid NSE（p<0.05） and the area under the ROC curve was 0.901, 0.892, and 0.601, respectively. Four different binary logistic diagnostic models were established based on pleural fluid CEA combined with pleural fluid NSE, pleural fluid ADA or ( and ) fever. Among them, the model established with the combination of pleural fluid CEA and pleural fluid ADA (logit (P) = 0.513 + 0.457*CEA-0.101*ADA) had the highest diagnostic value for malignant pleural effusion, and its predictive accuracy was high with an area under the ROC curve of 0.968 [95% confidence interval (0.947, 0.988)]. But the diagnostic efficacy of the diagnostic model could not be improved by adding pleural fluid NSE and fever. Conclusion The model established with the combination of CEA and ADA in the pleural fluid has a high differential diagnostic value for malignant pleural effusion and tuberculous pleural effusion, and NSE in the pleural fluid and fever cannot improve the diagnostic efficacy of the diagnostic model.

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Evaluation of Pleural Fluid Lactate for Diagnosis and Management of Parapneumonic Pleural Effusion

Clinical Laboratory ◽

10.7754/clin.lab.2016.160125 ◽

2016 ◽

Vol 62 (09/2016) ◽

Cited By ~ 1

Author(s):

Jose Santotoribio ◽

Hiba Alnayef-Hamwie ◽

Paula Batalha-Caetano ◽

Santiago Perez-Ramos ◽

Maria Pino

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Diagnosis And Management ◽

Parapneumonic Pleural Effusion

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Evaluation of diagnostic value of n-terminal pro brain natriuretic peptide in pleural fluid with cardiac origin

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20180746 ◽

2018 ◽

Vol 5 (3) ◽

pp. 912

Author(s):

Behzad Babapour ◽

Mohammad Mirzaaghazadeh ◽

Bita Shahbazzadegan ◽

Hadi Mohsenifar ◽

Alireza Mohammadzadeh ◽

...

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Diagnostic Value ◽

Common Finding ◽

Shortness Of Breath ◽

Male And Female ◽

Significant Difference ◽

Long Time ◽

Very High ◽

Exudative Pleural Effusion

Background: Pleural effusion is a common finding in patients. For a long time, a light criterion is used to analysis of pleural effusion for separation of transudative from exudative fluid. Sensitivity of light criteria is very high to determine exudative pleural effusion (98%). However, the ability of these criteria for ruling out of transudative effusions is low. For this reason, this study was carried out to determine the level of NT-proBNP in pleural fluid.Methods: A descriptive-analytic study was carried out on 21 patients with complaints of shortness of breath and diagnosis of pleural effusion. Pleural fluid was tapped in these patients and the following tests were performed: LDH, total protein, albumin, cell count, cell differentiation, cytology for malignant cells, ADA, smear for AFB, gram smear and culture.The results of all experiments were analyzed using SPSS V16.Results: Mean age of participants was 65 years. Male and female frequencies were 52.4 and 47.6, respectively. 33.3% of patients had CHF, 28.5% TB, 19.4% malignancy, 4.76% hydatid, and the rest left without diagnosis. A pleural fluid in 66.7% of participants was exudative and in 33.3% was transudative. The levels of NT-proBNP (Pg/ml) in serum and pleural fluid of patients with CHF were 11288.42 and 11036.81, but in malignant patient were 1721.68 and 713.59, respectively, and the levels of NT-proBNP in serum and pleural fluid in TB patient were 2429.30 and 2810.08, respectively. Also, there was no significant difference between the levels of serum and pleural effusion NT-proBNP in transudative and exudative fluid but the level of NT-proBNP was significantly higher in CHF patients compared to others.Conclusions: The results showed that the levels of NT-proBNP in serum and pleural fluid of cardiac patients are higher than other patients, but no significant difference in NT-proBNP between transudative and exudative pleural effusion.

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Diagnostic value of cytologic investigation of cell count differential of pleural fluid

Russian Pulmonology ◽

10.18093/0869-0189-2007-0-3-66-71 ◽

2007 ◽

pp. 66-71

Author(s):

O. G. Grigoruk ◽

A. F. Lazarev ◽

L. M. Bazulina

Keyword(s):

Breast Cancer ◽

Pleural Effusion ◽

Cell Count ◽

Pleural Fluid ◽

Lung Carcinoma ◽

Small Cell Lung Carcinoma ◽

Mesothelial Cell ◽

Diagnostic Value ◽

Primary Tumors ◽

Cell Lung Carcinoma

The cell count differential of pleural fluid sample is of great importance for estimation of the nature of pleural effusion. In the present article, we compared the efficiencies of routine cytology method with light microscopy, cytological examination with centrifuge Cytospin-4 and immunocytochemical methods. We have studied cytological samples from 1597 patients, with pleural effusion. Effusions associated with malignancies were reported in 22.7 % of patients including carcinomatosis (74.6 %), primary tumors of pleura (21.5 %), effusions associated with non epithelial malignancies (3.9 %). Benign pleural effusions were reactive (63.6 %), tuberculotic (13.5 %), "cholesterol pleurisy" and chylothorax (0.2 %). Carcinomatous pleuritis was found in patients with lung carcinoma (55.4 %), breast cancer (21.8 %) and ovary cancer (12.2 %). Specific malignant features (direct and indirect) were noted in pleural fluid on breast cancer, carcinomas of ovary, stomach, kidney, small cell lung carcinoma and squamous cell lung carcinoma. These features are hardly detected in patients with malignancies of intestines, prostate and endometria because these types of tumours are rarely metastatic to pleura. We were failed to define particular features of lung adenocarcinoma. The centrifuge Cytospin-4 was used in the most difficult cases (13.5 %) providing minimal number of presumable diagnosis. Primary tumours of pleura are the most difficult for detection. Immunocytochemical analysis found monoclonal mesothelial cell of НВЕМ 1 clone, cytokeratin, vimentin to be positive and carcinoembry onic antigen, Ber-EP4, CD-15 to be negative in the studied tumors.

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Assessment of the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions

Bionatura ◽

10.21931/rb/2021.06.03.10 ◽

2021 ◽

Vol 3 (3) ◽

pp. 1944-1947

Author(s):

Hanie Raji ◽

Seyed Hamid Borsi ◽

Mehrdad Dargahi MalAmir ◽

Ahmad Reza Asadollah Salmanpour

Keyword(s):

Pleural Effusion ◽

Tumor Marker ◽

Pleural Fluid ◽

Tumor Markers ◽

Low Cost ◽

High Specificity ◽

Diagnostic Value ◽

Pleural Effusions ◽

Cross Sectional ◽

The Mean

Pleural effusion is divided into exudative and transudative effusion, and the distinction between exudate and transudate requires multiple investigations of biochemical parameters and their comparison in pleural fluid and serum. This study aimed to assess the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions. This epidemiological and cross-sectional study was performed on 50 patients aged between 18 to 90 years with the diagnosis of exudative pleural effusion referred to Imam Khomeini Hospital in Ahvaz in 2018 and 2019. Demographic and clinical information of patients were collected. The pleural effusion was diagnosed based on physical examination and chest radiography. Pleural effusion was confirmed by thoracentesis. A pleural fluid sample was taken from all patients, and the levels of CEA, CA125, and CRP markers were measured in the pleural fluid. Differentiation of transudate and exudate pleural effusions was performed using Light criteria. The mean CEA and CA125 level of pleural fluid were significantly higher, and the mean CRP level of pleural fluid was significantly lower in patients with malignant diagnoses (P <0.05). Cut-off value with highest sensitivity and specificity in differentiating types of exudative pleural effusions was obtained for CEA tumor marker (greater than 49.8), CA125 tumor marker (greater than 814.02), and CRP marker (less than 7.56). Also, in differentiating types of exudative pleural effusions, CEA tumor marker had sensitivity (89.03%) and specificity (78.42%); CA125 tumor marker had sensitivity (53.18%) and specificity (62.44%), and CRP marker had sensitivity (82.16%), and specificity (89.05%) were. Although the tumor markers had high specificity in the present study, the low sensitivity of some of these tumor markers reduced their diagnostic value. On the other hand, given the numerous advantages of tumor markers, such as low cost and non-invasive, combining them with another can increase the diagnostic value and accuracy.

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Determination of tissue polypeptide-specific antigen in pleural fluid and serum from patients with pleural effusion

The International Journal of Biological Markers ◽

10.1177/172460089501000306 ◽

1995 ◽

Vol 10 (3) ◽

pp. 161-165 ◽

Cited By ~ 1

Author(s):

V. Villena ◽

J. Echave-Sustaeta ◽

A. Lopez-Encuentra ◽

P. Martin-Escribano ◽

J. Estenoz-Alfaro ◽

...

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Sensitivity And Specificity ◽

Specific Antigen ◽

Diagnostic Value ◽

Pleural Effusions ◽

Malignant Pleural Effusions ◽

Cytologic Analysis

As a tool for differentiating malignant and benign pleural effusions, we evaluated the diagnostic value of the assay of tissue polypeptide-specific antigen (TPS) in pleural fluid and serum, and of the pleural fluid TPS/serum TPS ratio in patients with pleural effusion. We studied prospectively 147 consecutive patients who had pleural effusions: 43 malignant pleural effusions and 104 benign pleural effusions. TPS levels were measured by RIA. The sensitivity and specificity of these measurements were: TPS in pleural fluid (cutoff 20,000 U/L): 0.21 and 0.98; TPS in serum (cutoff 300 U/L): 0.31 and 0.96; pleural fluid TPSI serum TPS ratio (cutoff 1200): 0.07 and 0.99. All these values enhanced the sensitivity of cytologic analysis of pleural fluid. However, we conclude that TPS assay in pleural fluid and serum, and the pleural fluid TPSI serum TPS ratio have limited diagnostic value in patients with pleural effusion.

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