The value of exfoliative cell cytology in the diagnosis of exudative pleural effusions

Tetikkurt, Cuneyt; Yilmaz, Nail; Tetikkurt, Seza; Gundogdu, Şule; Dişçi, Rian

doi:10.4081/monaldi.2018.944

Cited by 4 publications

(2 citation statements)

References 12 publications

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“…The database search yielded 3732 studies for screening with 181 potential studies identified for analysis. After full-text analysis, a total of 36 studies met inclusion criteria 2 3 7–40. A summary of the literature search is shown in figure 1.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic sensitivity of pleural fluid cytology in malignant pleural effusions: systematic review and meta-analysis

Kassirian

Hinton

Cuninghame

et al. 2022

Thorax

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BackgroundPleural fluid cytology is an important diagnostic test used for the investigation of pleural effusions. There is considerable variability in the reported sensitivity for the diagnosis of malignant pleural effusions (MPE) in the literature.ObjectiveThe purpose of this review is to determine the diagnostic sensitivity of pleural fluid cytology for MPE, both overall and by tumour type, to better inform the decision-making process when investigating pleural effusions.Data sourcesA literature search of EMBASE and MEDLINE was performed by four reviewers. Articles satisfying inclusion criteria were evaluated for bias using the QUADAS-2 tool.Data extractionFor quantitative analysis, we performed a metaanalysis using a binary random-effects model to determine pooled sensitivity. Subgroup analysis was performed based on primary cancer site and meta-regression by year of publication.SynthesisThirty-six studies with 6057 patients with MPE were included in the meta-analysis. The overall diagnostic sensitivity of pleural fluid cytology for MPE was 58.2% (95% CI 52.5% to 63.9%; range 20.5%–86.0%). There was substantial heterogeneity present among studies (I2 95.5%). For primary thoracic malignancies, sensitivity was highest in lung adenocarcinoma (83.6%; 95% CI 77.7% to 89.6%) and lowest in lung squamous cell carcinoma (24.2%; 95% CI 17.0% to 31.5%) and mesothelioma (28.9%; 95% CI 16.2% to 41.5%). For malignancies with extrathoracic origin, sensitivity was high for ovarian cancer (85.2%; 95% CI 74.2% to 96.1%) and modest for breast cancer (65.3%; 95% CI 49.8% to 80.8%).ConclusionsPleural fluid cytology has an overall sensitivity of 58.2% for the diagnosis of MPE. Clinicians should be aware of the high variability in diagnostic sensitivity by primary tumour type as well as the potential reasons for false-negative cytology results.PROSPERO registration numberCRD42021231473.

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Section: Resultsmentioning

confidence: 99%

Diagnostic sensitivity of pleural fluid cytology in malignant pleural effusions: systematic review and meta-analysis

Kassirian

Hinton

Cuninghame

et al. 2022

Thorax

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“…Therefore, it is more sensitive to detect tumor markers in pleural effusion (2). Exfoliative cytology characterized by high specificity and low sensitivity is often used clinically to distinguish benign and malignant pleural effusion (3). Carcinoembryonic antigen (CEA) is present in endoderm-derived digestive system cancer and normal digestive tract tissues, and also present in a trace amount in normal human serum, which can be used as a diagnostic marker for breast cancer, lung cancer, and colorectal cancer, but its specificity and sensitivity are not high (4).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of combination of exfoliative cytology with CA125, CEA, NSE, CYFRA21-1 and CA15-3 for lung cancer

Zhang

Liu

Xia

et al. 2022

Revista Romana De Medicina De Laborator

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Background: To explore the diagnostic value of combination of exfoliative cytology with detection of tumor markers carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA), neuron specific enolase (NSE), cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) and CA15-3 for lung cancer. Methods: A total of 256 patients were enrolled, including 164 males and 92 females aged (64.51±22.68) years old. Among them, 189 patients (100 males and 89 females) were randomly selected as Tumor group, and the remaining 67 patients were used for validation. Another 514 healthy people receiving physical examination in our hospital during the same period were selected, from which 397 cases (266 males and 131 females) were randomly selected as No Tumor group, and the remaining 117 cases were used for validation. The biochemical criteria were detected in all subjects. The diagnostic value of each index for lung cancer was analyzed using receiver operating characteristic (ROC) curves. Results: The results of ROC curve analysis revealed that in Tumor group, the area under curve (AUC) of exfoliative cytology, CA125, CYFRA21-1, CA15-3, CEA and NSE was ≥0.7, while that of CA72-4, CA19-9, TSGF, AFP, CA242, SCCAg and CA50 was <0.7. The indices in each factor were comprehensively assessed, and then exfoliative cytology, CA125, CA15-3, CYFRA21-1, CEA and NSE were screened to establish the lung cancer prediction model. The diagnostic value was comparable between the prediction model and the combined detection of 9 indices (Z=1.682, P=0.079). Conclusions: The lung cancer prediction model balances sensitivity and specificity without reducing the diagnostic efficiency.

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Epithelial Membrane Antigen, Vimentin, Desmin, Calretinin, E-Cadherin on Cell Block Preparations to Distinguish Well Differentiated Adenocarcinoma from Benign, Reactive, Atypical Mesothelial Cells

Jaiswal¹,

Makrande²,

Vagha³

2021

jemds

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BACKGROUND Inconclusive cytomorphology often results due to failure to distinguish between adenocarcinoma cells from benign, reactive, atypical mesothelial cells in effusion specimens. To resolve such dilemmas, auxiliary techniques like immunohistochemistry were utilised to reach a definitive diagnosis for better treatment and management of patients. We wanted to compare cytodiagnosis achieved on cell block preparations with the cytodiagnosis on conventional smear and perform immunohistochemistry for epithelial membrane antigen (EMA), calretinin, desmin, vimentin and E-cadherin on cell block preparation of the fluids in cases of indistinguishable cytomorphology of adenocarcinoma and reactive, atypical, and benign mesothelial hyperplasia. METHODS The immunohistochemical markers namely EMA, calretinin, vimentin, desmin and Ecadherin were applied on cell blocks employing streptavidin-biotin method. Immunohistochemistry was interpreted by giving scores to the percentage of stained cells. RESULTS EMA and E-cadherin had 100 % sensitivity in diagnosing adenocarcinoma whereas calretinin, vimentin and desmin were 100 % sensitive in diagnosing reactive, atypical mesothelial carcinoma on the cell block preparations. CONCLUSIONS Immunocytochemistry of fluid should be carried out on the cell block preparation where cytological diagnosis on conventional smear and cell block fails to detect malignant cells in the preparation. KEY WORDS Cell Block, Adenocarcinoma, Mesothelial Cells, Immunohistochemistry, EMA, Calretinin, Vimentin, Desmin, E-Cadherin

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The value of exfoliative cell cytology in the diagnosis of exudative pleural effusions

Cited by 4 publications

References 12 publications

Diagnostic sensitivity of pleural fluid cytology in malignant pleural effusions: systematic review and meta-analysis

Diagnostic sensitivity of pleural fluid cytology in malignant pleural effusions: systematic review and meta-analysis

Diagnostic value of combination of exfoliative cytology with CA125, CEA, NSE, CYFRA21-1 and CA15-3 for lung cancer

Epithelial Membrane Antigen, Vimentin, Desmin, Calretinin, E-Cadherin on Cell Block Preparations to Distinguish Well Differentiated Adenocarcinoma from Benign, Reactive, Atypical Mesothelial Cells

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