Evaluating the adult with new-onset pleural effusion

Kruger, Danielle

doi:10.1097/01.jaa.0000431507.82701.f7

Cited by 4 publications

(2 citation statements)

References 5 publications

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“…Because in the case of a transudate, aetiology and therapy are directed to the underlying congestive heart failure, cirrhosis, or nephrosis. Alternatively, exudates are usually taken as a sign of, inflammatory disorders or malignancy, leading to more extensive diagnostic procedures [4,5]. …”

Section: Introductionmentioning

confidence: 99%

Can cholesterol be used to distinguish pleural exudates from transudates? evidence from a bivariate meta-analysis

et al. 2014

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BackgroundMany studies have investigated whether pleural cholesterol levels can aid in diagnosis of pleural exudates, and the results have varied considerably. To gain a more reliable answer to this question, we meta-analyzed the literature on using pleural cholesterol or the ratio of cholesterol in pleural fluid to cholesterol in serum (P/S cholesterol ratio) as diagnostic tests to help identify pleural exudates.MethodsLiterature databases were systematically searched for studies examining accuracy of pleural cholesterol or P/S cholesterol ratios for diagnosing pleural exudates. Data on sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR) were pooled using bivariate-effects models. Summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were used to summarize overall test performance.ResultsOur meta-analysis included up to 20 studies involving 3,496 subjects. Summary estimates for pleural cholesterol in the diagnosis of pleural exudates were as follows: sensitivity, 0.88 (95%CI 0.84 to 0.92); specificity, 0.96 (95% CI 0.92 to 0.98); PLR, 20.31 (95% CI 11.21 to 36.78); NLR, 0.12 (95% CI 0.09 to 0.17); DOR, 167.06 (95% CI 76.79 to 363.95); and AUC 0.97 (95% CI 0.95 to 0.98). The corresponding summary performance estimates for using the P/S cholesterol ratio were as follows: sensitivity, 0.94 (95% CI 0.92 to 0.96); specificity, 0.87 (95% CI 0.83 to 0.91); PLR 7.46 (95% CI, 5.47 to 10.19); NLR, 0.07 (95% CI 0.05 to 0.10); DOR, 107.74 (95% CI 60.91 to 190.60); and AUC 0.97 (95% CI 0.95 to 0.98).ConclusionsBoth pleural cholesterol level and the P/S cholesterol ratio are helpful for the diagnosis of pleural exudates. Nevertheless, the results of pleural cholesterol assays should be interpreted in parallel with the results of traditional tests and clinical information.

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Section: Introductionmentioning

confidence: 99%

Can cholesterol be used to distinguish pleural exudates from transudates? evidence from a bivariate meta-analysis

et al. 2014

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“…Some studies have pointed out that MPE is caused by tumor-induced angiogenesis, and some scholars have also pointed out that vascular endothelial growth factor may be an important cause of MPE by increasing vascular endothelial permeability and exudation ( 15 ). Some studies have shown that there are more than 1.5 million new patients with pleural effusion each year in the United States, and MPE caused by cancer accounts for the vast majority of such patients ( 16 , 17 ). A clinical study involving 1783 patients with MPE found that bronchial lung cancer, particularly lung adenocarcinoma, accounted for disease in 36% of cases ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Survival Benefits for Pulmonary Adenocarcinoma With Malignant Pleural Effusion After Thoracoscopic Surgical Treatment: A Real-World Study

et al. 2022

Front. Oncol.

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ObjectivesMalignant cells in the pleural fluid or pleural metastasis are classified as stage IV non-small cell lung cancer. Radical surgery is generally considered not suitable for such patients. The aim of our study was to discuss the effectiveness of video-assisted thoracoscopic surgery (VATS) in such patients.MethodsA retrospective analysis of the clinical records of 195 patients was performed. These patients were all diagnosed with locally advanced pulmonary adenocarcinomas with malignant pleural effusion (MPE, M1a) but no distant organ metastasis. The 195 patients included 96 patients who underwent VATS plus chemotherapy and 99 patients who received thoracic drainage plus chemotherapy. The baseline characteristics of the patients included age, gender, smoking history, Eastern Cooperative Oncology Group (ECOG) score, and number of chemotherapy cycles (2–4 cycles or >4 cycles); we also analyzed clinical characteristics including the specific surgical options of the VATS group.ResultsIn multivariate analysis, when compared to the thoracic drainage group, the VATS group remained significantly associated with the overall survival [HR=0.480 (95%CI 0.301-0.765)]; when compared to the lobectomy, the sub-lobectomy and the palliative surgery, remained significantly associated with the overall survival [HR=0.637 (95%CI 0.409-0.993) and HR=0.548 (95%CI 0.435-0.832), respectively]. The median survival time (MST) of patients who underwent VATS (n = 96, 49.2%) was 25 months (95% CI 22.373–27.627) whereas the patients who received thoracic drainage (n = 99, 50.8%) was 11 months (95% CI 9.978–12.022). For patients who underwent VATS, the MST of patients who received a lobectomy (n = 50, 52.1%) was 27 months (95% CI 22.432–31.568), the MST of patients who received a sub-lobectomy plus pleurodesis (n = 26, 27.1%) was 27 months (95% CI 19.157–34.843), and the MST of patients who received only pleurodesis (n = 20, 20.8%) was 12 months (95% CI 7.617–16.383).ConclusionFor pulmonary adenocarcinomas with MPE, receiving a lobectomy or sub-lobectomy plus pleurodesis with VATS was associated with improved survival compared with patients who only received thoracic drainage and chemotherapy. Our results and previously published data may justify the use of VATS for treating pulmonary adenocarcinomas with MPE.

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ACR Appropriateness Criteria® Workup of Pleural Effusion or Pleural Disease

Morris,

Henry,

Raptis

et al. 2024

Journal of the American College of Radiology

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Evaluating the adult with new-onset pleural effusion

Abstract: PAs play an essential role in recognizing new-onset pleural effusion in adults. This article reviews risk factors, patient assessment, diagnostic testing, initial management, and treatment.

Cited by 4 publications

References 5 publications

Can cholesterol be used to distinguish pleural exudates from transudates? evidence from a bivariate meta-analysis

Can cholesterol be used to distinguish pleural exudates from transudates? evidence from a bivariate meta-analysis

Survival Benefits for Pulmonary Adenocarcinoma With Malignant Pleural Effusion After Thoracoscopic Surgical Treatment: A Real-World Study

ACR Appropriateness Criteria® Workup of Pleural Effusion or Pleural Disease

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