Diagnostic yield of pleural fluid cytology in malignant effusions: an Australian tertiary centre experience

Loveland, Paula; Christie, Micheal; Hammerschlag, Gary; Irving, Louis; Steinfort, Daniel P.

doi:10.1111/imj.13991

Cited by 46 publications

(51 citation statements)

References 27 publications

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“…Seventy‐one studies were designed as a cohort, and nine were case‐control studies . Thirty‐three studies explicitly mentioned that the subjects were recruited consecutively …”

Section: Resultsmentioning

confidence: 99%

Are we ready to develop a tiered scheme for the effusion cytology? A comprehensive review and analysis of the literature

Farahani

Baloch

2019

Diagnostic Cytopathology

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Background: Cytology is widely utilized in the initial evaluation of fluid accumulation in the body cavities. The aim of this study was to determine the accuracy of cytology in distinguishing between benign and malignant (MAL) effusions. Methods:A comprehensive and systematic review of the literature was conducted to evaluate the accuracy of serous effusion cytology (SEC) against tissue biopsy/resection histology, imaging, or clinical follow-up as the reference test. Risk of publication bias and level of heterogeneity in the included studies was assessed. Meta-regression was performed to assess the effect of various variables on the accuracy of SEC. Results: Eighty studies met the inclusion criteria for meta-analysis comprising of 34 941 samples; of which 52 (0.2%), 22 202 (72.7%), 194 (0.6%), 711 (2.3%), and 6507 (21.3%) could be reclassified as nondiagnostic (ND), negative for malignancy (NFM), atypical (atypia of uncertain significance-AUS), suspicious for malignancy (SFM), and malignant (MAL), respectively. On follow-up, the mean risk of malignancy for ND, NFM, AUS, SFM, MAL was 17.4%, 20.7%, 65.9%, 81.8%, and 98.9%, respectively. A total of 73 studies were included in estimating the diagnostic accuracy of SEC. The bivariate mixed-effect model estimated the SEC sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio as 73.1%, 99.9%, 7850.6%, 2112.2%, and 0.27%, respectively. Conclusion: Serous effusion cytology shows high specificity and moderate sensitivity in the evaluation of serous effusions. A tiered classification scheme can improve the consistency of terminology for reporting SEC results, thus improving communication between the pathologists and clinical team, and quality of patient care. K E Y W O R D S analysis, classification scheme, comprehensive review, risk of malignancy, serous effusion cytology 1 | INTRODUCTION Serous effusion cytology (SEC) has been widely utilized in the initial evaluation of the etiology of fluid accumulation in the body cavities. Serous fluid can form in body cavities due to various inflammatory, infectious, and benign or malignant neoplasms. Malignancy is the underlying cause of serous effusion in 10% to 61% cases. 1,2 A majority of malignant effusions are caused by metastasis from adenocarcinoma of lung, breast, gastrointestinal, and female genital tract. 2,3 Malignant mesothelioma caninitially present as a serous effusion in up to 10% to 53% cases. 4-8

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“…Seventy‐one studies were designed as a cohort, and nine were case‐control studies . Thirty‐three studies explicitly mentioned that the subjects were recruited consecutively …”

Section: Resultsmentioning

confidence: 99%

Are we ready to develop a tiered scheme for the effusion cytology? A comprehensive review and analysis of the literature

Farahani

Baloch

2019

Diagnostic Cytopathology

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“…Pleural effusions are a common entity, and although around a third are due to malignancy, 1 there is a wide differential diagnosis. The British Thoracic Society (BTS) Pleural Disease guidelines recommend initial pleural aspiration, 2 often of large volume to relieve breathlessness, before proceeding to further investigations and potentially definitive treatments.…”

Section: Introductionmentioning

confidence: 99%

Critical analysis of the utility of initial pleural aspiration in the diagnosis and management of suspected malignant pleural effusion

et al. 2020

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IntroductionCurrent guidelines recommend an initial pleural aspiration in the investigation and management of suspected malignant pleural effusions (MPEs) with the aim of establishing a diagnosis, identifying non-expansile lung (NEL) and, at times, providing a therapeutic procedure. A wealth of research has been published since the guidelines suggesting that results and outcomes from an aspiration may not always provide sufficient information to guide management. It is important to establish the validity of these findings in a ‘real world’ population.MethodsA retrospective analysis was conducted of all patients who underwent pleural fluid (PF) sampling, in a single centre, over 3 years to determine the utility of the initial aspiration.ResultsA diagnosis of MPE was confirmed in 230/998 (23%) cases, a further 95/998 (9.5%) were presumed to represent MPE. Transudative biochemistry was found in 3% of cases of confirmed MPE. Positive PF cytology was only sufficient to guide management in 45/140 (32%) cases. Evidence of pleural thickening on CT was associated with both negative cytology (χ2 1df=26.27, p<0.001) and insufficient samples (χ2 1df=10.39, p=0.001). In NEL 44.4% of patients did not require further procedures after pleurodesis compared with 72.7% of those with expansile lung (χ2 1df=5.49, p=0.019). In patients who required a combined diagnostic and therapeutic aspiration 106/113 (93.8%) required further pleural procedures.ConclusionsAn initial pleural aspiration does not achieve either definitive diagnosis or therapy in the majority of patients. A new pathway prioritising symptom management while reducing procedures should be considered.

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“…Vice versa, metastatic malignant cells can be deceptively bland and easily dismissed as reactive [5]. The diagnostic precision of conventional effusion cytology based on cytomorphology alone is still far from satisfactory, with reported sensitivity and specificity values as low as 67.2 and 85.9%, respectively, for detection of malignancy [6].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of the EZH2 Immunomarker in Malignant Effusion Cytology

Ang

Tan

Karim³

et al. 2019

Acta Cytologica

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Background: Differentiating reactive mesothelial cells from metastatic carcinoma in effusion cytology is a challenging task. The application of at least 4 monoclonal antibodies including 2 epithelial markers (Ber-EP4, MOC-31, CEA, or B72.3) and 2 mesothelial markers (calretinin, WT-1, CK5/6, or HBME-1) are often useful in this distinction; however, it is not readily available in many resource-limited developing countries. Aberrant immunoexpression of enhancer of zeste homolog 2 (EZH2), a transcriptional repressor involved in cancer progression, is observed widely in various malignancy. In this study, we evaluate the diagnostic value of EZH2 as a single reliable immunomarker for malignancy in effusion samples. Methods: A total of 108 pleural, peritoneal, and pericardial effusions/washings diagnosed as unequivocally reactive (n = 41) and metastatic carcinoma (n = 67) by cytomorphology over 18 months were reviewed. Among the metastatic carcinoma cases, 54 were adenocarcinoma and others were squamous cell carcinoma (n = 1), carcinosarcoma (n = 1), and carcinoma of undefined histological subtypes (n = 11). Cell block sections were immunostained by EZH2 (Cell Marque, USA). The percentages of EZH2-immunolabeled cells over the total cells of interest were calculated. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off score to define EZH2 immunopositivity. Results: A threshold of 8% EZH2-immunolabeled cells allows distinction between malignant and reactive mesothelial cells, with 95.5% sensitivity, 100% specificity, 100% positive predictive value, and 93.2% negative predictive value (p < 0.0001). The area under the curve was 0.988. Conclusion: EZH2 is a promising diagnostic biomarker for malignancy in effusion cytology which is inexpensive yet trustworthy and could potentially be used routinely in countries under considerable economic constraints.

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Diagnostic yield of pleural fluid cytology in malignant effusions: an Australian tertiary centre experience

Abstract: Tumour type is an important determinant of pleural fluid cytology diagnostic yield. Cytology has good sensitivity and specificity for the diagnosis of adenocarcinoma, but if another tumour type is suspected, particularly mesothelioma, clinicians should be aware of the limitations.

Cited by 46 publications

References 27 publications

Are we ready to develop a tiered scheme for the effusion cytology? A comprehensive review and analysis of the literature

Are we ready to develop a tiered scheme for the effusion cytology? A comprehensive review and analysis of the literature

Critical analysis of the utility of initial pleural aspiration in the diagnosis and management of suspected malignant pleural effusion

Diagnostic Value of the EZH2 Immunomarker in Malignant Effusion Cytology

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