A comparative study of diagnostic accuracy in 3026 pleural biopsies and matched pleural effusion cytology with clinical correlation

Abstract

Background: Pleural effusion can be caused by a wide range of benign and malignant conditions. Pleural biopsy and effusion cytology represent two key methods of pathological diagnosis. To compare the performance these two methods, a large cohort of matched pleural biopsy and effusion cytology with clinical followup was reviewed.Methods: Pleural biopsies and effusion cytology specimens over a period of 18 years were retrieved. Cytology specimens collected within 7 days of pleural biopsy were matched. Reports were reviewed, and the cause for pleural effusion was determined by hospital disease coding and clinical data.Results: Totally, 3026 cases were included. The leading cause of benign effusion was tuberculosis (n = 650). Malignant pleural effusion (MPE) was more common in older females (p < 0.001) and mostly due to lung cancer (n = 959), breast cancer (n = 64), and mesothelioma (n = 48). The inadequate/insufficient (B1/C1) rate of biopsy was higher than cytology (15.6% vs. 0.3%) but the rates for other diagnostic categories were similar. Biopsy and cytology showed a correlation coefficient of 0.315, improving to 0.449 when inadequate/insufficient (B1/C1) cases were excluded. The ROM for benign cytology (C2) was lower than biopsy (B2) (p < 0.001). Compared with biopsy, the diagnostic accuracy was higher in cytology overall and for metastatic carcinomas (p < 0.001) but lower for hematolymphoid malignancies (p = 0.014) and mesotheliomas (p = 0.002).Conclusions: These results suggest that effusion cytology may be better for confirming benignity and diagnosing carcinomatous MPE. In these cases, pleural biopsy may be withheld to reduce procedural risks. However, for suspected hematolymphoid malignancies and mesothelioma, biopsy should be considered.

Concordance between conventional cytology and cell block of suspected malignant pleural effusion: A record-based study in a tertiary care center of eastern India

“…In our study of 150 cases, there were more male than female patients, which is similar to other studies like Shivakumarswamy et al, 2 Thapar et al, 3 Rani et al, 4 Poon et al 10 The majority of the patients are over 40 years of age. This may be explained by higher smoking prevalence in the male population, along with the practice of delayed health seeking behaviour.…”

The role of cytology in densely populated territories: An experience from Hong Kong

“…Aspiration and brush cytology are used at a rate similar to the core biopsy rate, and they are not uncommonly performed together. The local health care infrastructure is ideal for quality and performance reviews, large-scale diagnostic studies with long follow-up periods, 6,7 cytology correlation on uncommon histologic entities, [8][9][10] and machine learning/big data analysis. 11 Targeted therapies, including HER2, EGFR, and PD1/PDL1 inhibitors as well as tyrosine inhibitors and anti-CD19 and CD20 monoclonal antibodies, are supported by funding from government and/or nongovernment organizations, and this has resulted in a constant demand for relevant biomarker testing.…”

“…Aspiration and brush cytology are used at a rate similar to the core biopsy rate, and they are not uncommonly performed together. The local health care infrastructure is ideal for quality and performance reviews, large‐scale diagnostic studies with long follow‐up periods, 6,7 cytology correlation on uncommon histologic entities, 8–10 and machine learning/big data analysis 11 …”

Reply to: A comparative study of diagnostic accuracy in 3026 pleural biopsies and matched pleural effusion cytology with clinical correlation: A methodological issue

“…We thank Zhang and colleagues for their readership and letter. 1 , 2 Zhang et al have commented that diagnostic odds ratio (DOR), negative‐to‐positive likelihood ratio (LR), and area under receiver operating characteristic curves (AUC) could serve additional metrics for exploring the diagnostic performance of pleural biopsy and pleural effusion, and that the lack of AUC constitutes methodological insufficiency. We are grateful for their interesting suggestions that merit discussion.…”