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Investigating unilateral pleural effusions: the role of cytology

Authors :
Duneesha De Fonseka
David T Arnold
Nick A Maskell
Mary Brett
Andrew R L Medford
Siobhan Perry
John E Harvey
Anna J Morley
Source :
Arnold, D T, De Fonseka, D, Perry, S, Morley, A, Harvey, J E, Medford, A, Brett, M & Maskell, N A 2018, ' Investigating unilateral pleural effusions : the role of cytology ', European Respiratory Journal, vol. 52, no. 5, 1801254 . https://doi.org/10.1183/13993003.01254-2018
Publication Year :
2018
Publisher :
European Respiratory Society (ERS), 2018.

Abstract

The vast majority of undiagnosed unilateral pleural effusions have fluid sent for cytological analysis. Despite widespread use, there is uncertainty about its sensitivity to diagnose malignant pleural effusions (MPEs). Our aim was to ascertain the utility of cytology using a large prospective cohort.Consecutive patients presenting with an undiagnosed unilateral pleural effusion were recruited to this UK-based study. All had pleural fluid sent for cytological analysis. Cytological sensitivity was based on the final diagnosis at 12 months, confirmed by two consultants.Over 8 years, 921 patients were recruited, of which 515 had a MPE. Overall sensitivity of fluid cytology to diagnose malignancy was 46% (95% CI 42–58%). There was variation in sensitivity depending on cancer primary, with mesothelioma (6%) and haematological malignancies (40%) being significantly lower than adenocarcinomas (79%). MPEs secondary to ovarian cancer had high pick-up rates (95%). In asbestos-exposed males with exudative effusions, the risk of MPE was 60%, but cytological sensitivity was 11%.This is the largest prospective study of pleural fluid cytology and informs discussions with patients about the likely requirement for investigations following thoracentesis. In patients presenting with a clinical suspicion of mesothelioma, cytological sensitivity is low, so more definitive investigations could be performed sooner.

Details

ISSN :
13993003 and 09031936
Volume :
52
Database :
OpenAIRE
Journal :
European Respiratory Journal
Accession number :
edsair.doi.dedup.....bc17ad520f2ab8c58b8beb5312b0ff8d
Full Text :
https://doi.org/10.1183/13993003.01254-2018