Sensitivity of Initial Thoracentesis for Malignant Pleural Effusion Stratified by Tumor Type in Patients with Strong Evidence of Metastatic Disease

Abstract

Background: Thoracentesis with cytological examination of pleural fluid is the initial test of choice for evaluation of pleural effusions in patients with suspected malignant pleural effusion (MPE). There is limited data on the sensitivity of thoracentesis stratified by tumor type. A better understanding of stratified sensitivities is of clinical interest, and may guide early and appropriate referral for pleural biopsy. Objective: The primary objective was sensitivity of thoracentesis with pleural fluid cytology stratified by tumor type. Methods: This is a retrospective cohort study of consecutive patients with a solid tumor malignancy with proven or strong suspicion for metastatic disease with new pleural effusions that underwent an initial thoracentesis. Only patients with metastatic disease were included. Results: Of the 725 patients examined, 63% had pleural fluid cytology positive for malignancy. Sensitivity of thoracentesis varied from a low of 0.38 (95% CI 0.13–0.68) in head and neck malignancy, 0.38 (95% CI 0.15–0.65) in sarcoma, and 0.53 (95% CI 0.34–0.72) in renal cancer to a high of 93 (95% CI 88–97) in breast cancer, and 100 (95% CI 0.82–100) in pancreatic cancer. Factors associated with an increased risk of MPE included larger amount of fluid drained (p = 0.014) and higher pleural fluid protein (p = 0.002). The only factor associated with decreased risk of MPE if first cytology was negative for malignancy was the presence of contralateral effusion (p = 0.005). Conclusions: Sensitivity of thoracentesis for solid tumors varies significantly depending on the type of tumor and is lowest in those with sarcomas, head and neck malignancies, and renal cell cancers.

Pleural effusions associated with squamous cell lung carcinoma have a low diagnostic yield and a poor prognosis

“…The higher total yield of 73.2% of initial thoracentesis in our cohort, compared to the contemporary literature, is related to a high number of adenocarcinoma patients in this cohort. Similar results are reported by Grosu and colleagues (12). We have shown that such a difference in the thoracentesis yield with different tumor types persists even with subsequent thoracentesis.…”

“…After non-diagnostic thoracentesis, pleural biopsy is usually performed via medical pleuroscopy, video-assisted thoracoscopic surgery (VATS) or image guidance (10,11). There is limited literature on the diagnostic yield of cytology followed by pleural biopsy in patients with NSCLC related pleural effusions (12). In addition, the prognosis of patients with subtypes of NSCLC with pleural effusions has not been compared.…”

Driverless artificial intelligence framework for the identification of malignant pleural effusion

“…The high morbidity of MPE continues to rise and therefore causes a heavy health care burden [ 28 ]. An ability to distinguish between MPE and BPE with considerable accuracy is clinically significant to avoid the deferred diagnosis of MPE [ [29] , [30] , [31] , [32] ]. Thus, this clinical study aiming to precisely differentiate MPE from BPE was of great public health implications.…”

Cytohistological Correlation in Pleural Effusions Based on the International System for Reporting Serous Fluid Cytopathology

“…Several recent publications have looked at the risk of malignancy (ROM) for each of these categories. They have shown that values vary between affected cavities [ 5 , 6 , 17 , 18 , 19 , 20 , 21 , 22 ]. Most studies, however, were published before the development and implementation of TIS, with few exceptions [ 5 , 6 , 17 , 18 , 19 , 20 , 21 , 22 ].…”