Predictors of Pleural Malignancy in Patients With Pleural Effusion Undergoing Thoracoscopy

Ferrer, Jaume; Roldán, Javier de Gracia; Teixidor, Joan Rodés; Pallisa, Esther; Gich, Ignasi; Morell, Ferrán

doi:10.1378/chest.127.3.1017

Cited by 92 publications

(60 citation statements)

References 22 publications

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“…In the current study, the diagnosis of tuberculous pleural effusion was established by the presence of Mycobacterium tuberculosis in pleural biopsy specimen, or by demonstration of caseating granulomas and/ or epithelioid cell granulomas in pleural tissue with no evidence of other granulomatous diseases. As expected, in the present study, we observed that 40.0% (333/833) of the patients who underwent MT were confirmed to suffer from tuberculous pleural effusion, which was much higher than the 5.9% reported in the study from New Zealand [12] , the 5.6% from the United Kingdom [14] , the 3.2% from Spain [22] , the 2.7% from France [13] , the 2.0% from Denmark [23] , and even the 0% from the United States [24] .…”

Section: Discussionsupporting

confidence: 80%

Efficacy and Safety of Diagnostic Thoracoscopy in Undiagnosed Pleural Effusions

Wang¹,

Yang²,

Wang³

et al. 2015

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Background: The differential diagnosis of pleural effusions can present a considerable challenge, and the etiology of pleural effusions varies depending on the population studied. Objective: This study aimed to assess the efficacy and safety of medical thoracoscopy in the diagnosis of patients with undiagnosed pleural effusions in a Chinese population. Methods: Between July 2005 and June 2014, medical thoracoscopy (MT) using the semirigid instrument was performed in 833 patients with pleural effusions of unknown etiology in our Institute, where diagnostic thoracocentesis or/and blind pleural biopsy had failed to yield an answer. Demographic, radiographic, procedural, and histological data were recorded and analyzed. Results: During this 9-year study, satisfactory pleural biopsy samples were obtained in 833 patients, and MT revealed malignant pleural effusion in 342 (41.1%) patients, benign pleural effusion in 429 (51.5%) patients, and 62 (7.4%) patients could not get definite diagnoses. The overall diagnostic efficiency of MT was 92.6% (771/833). After MT, the only severe complication was empyema, seen in 3 patients (0.4%). The most common minor complication was transient chest pain (44.1%) from the indwelling chest tube. Conclusions: MT is an effective and safe procedure for diagnosing pleural effusions of undetermined causes. In areas with high tuberculosis prevalence, MT should be particularly helpful in the differential diagnosis of tuberculous pleural effusion.

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Section: Discussionsupporting

confidence: 80%

Efficacy and Safety of Diagnostic Thoracoscopy in Undiagnosed Pleural Effusions

Wang¹,

Yang²,

Wang³

et al. 2015

Respiration

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“…The clinical predictors for malignant pleural effusions include older age, a symptomatic period 1 1 month, absence of fever, blood-tinged pleural effusion, large or massive pleural effusion, and chest CT scan findings suggestive of malignancy [31][32][33] . Thus, it is not surprising that one of the patients with malignant pleural effusion had a pleural eosinophil count of 70% [27] .…”

Section: Discussionmentioning

confidence: 99%

The Prevalence and Diagnostic Significance of Eosinophilic Pleural Effusions: A Meta-Analysis and Systematic Review

Oba

Abu-Salah²

2011

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(21 vs. 30%; p = 0.01). The likelihood of malignancy was inversely correlated with the pleural fluid eosinophil counts. The likelihood of idiopathic effusion was significantly higher in EPEs than in non-EPEs. Conclusions: Malignancy was the most common cause of EPEs. EPEs appeared to be a negative predictor of malignancy when a pleural fluid eosinophil count was extremely high. EPEs were more likely to be idiopathic as compared with non-EPEs.

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“…Ferrer et al have suggested that using four criteria (no fever, symptomatic for more than 1 month, blood-tinged fluid, CT findings suggestive for malignancy) was found adequately valuable in 95% of the patients. (14) The reasons of having more male patients and in old ages, underlying malignancy in 46% of patients might be related with that diagnostic algorithm. Similar age range and male predominance have been also reported in several studies.…”

Section: Discussion:-mentioning

confidence: 99%