Critical analysis of the utility of initial pleural aspiration in the diagnosis and management of suspected malignant pleural effusion

IntroductionCurrent guidelines recommend an initial pleural aspiration in the investigation and management of suspected malignant pleural effusions (MPEs) with the aim of establishing a diagnosis, identifying non-expansile lung (NEL) and, at times, providing a therapeutic procedure. A wealth of rese...

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Veröffentlicht in:BMJ open respiratory research 2020-09, Vol.7 (1), p.e000701, Article 000701
Hauptverfasser: Mercer, Rachel Mary, Varatharajah, Rebecca, Shepherd, Gillian, Lu, Qiang, Castro-Añón, Olalla, McCracken, David J, Dudina, Alexandra, Addala, Dinesh, Tsikrika, Stamatoula, George, Vineeth, Banka, Radhika, Asciak, Rachelle, Hassan, Maged, Hallifax, Robert, Bedawi, Eihab O, Shute, Janis Kay, Rahman, Najib M
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Sprache:eng
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Zusammenfassung:IntroductionCurrent guidelines recommend an initial pleural aspiration in the investigation and management of suspected malignant pleural effusions (MPEs) with the aim of establishing a diagnosis, identifying non-expansile lung (NEL) and, at times, providing a therapeutic procedure. A wealth of research has been published since the guidelines suggesting that results and outcomes from an aspiration may not always provide sufficient information to guide management. It is important to establish the validity of these findings in a ‘real world’ population.MethodsA retrospective analysis was conducted of all patients who underwent pleural fluid (PF) sampling, in a single centre, over 3 years to determine the utility of the initial aspiration.ResultsA diagnosis of MPE was confirmed in 230/998 (23%) cases, a further 95/998 (9.5%) were presumed to represent MPE. Transudative biochemistry was found in 3% of cases of confirmed MPE. Positive PF cytology was only sufficient to guide management in 45/140 (32%) cases. Evidence of pleural thickening on CT was associated with both negative cytology (χ2 1df=26.27, p
ISSN:2052-4439
2052-4439
DOI:10.1136/bmjresp-2020-000701