Chest
Clinical InvestigationsEfficacy of Pleural Needle Biopsy and Pleural Fluid Cytopathology in the Diagnosis of Malignant Neoplasm Involving the Pleura
Section snippets
Methods
Three hundred and forty-eight consecutive patients who underwent needle biopsy of the pleura between 1966 and 1972 were identified in the surgical pathology files of The Johns Hopkins Hospital. The biopsies were performed with the Abrams pleural punch biopsy needle. Of these, cytopathologic examination of pleural fluid had also been performed, and follow-up information was available on 271 patients. This group forms the basis of the study.
The clinical records of these 271 patients were reviewed
Results
The causes of the pleural effusions of the 271 patients are shown in Table 1. A malignant tumor involving the pleura was present in 95 cases. The effusions were due to various non-neoplastic diseases in 176 intsances. The most common of these was tuberculosis (56 cases), followed closely by congestive heart failure (46) and bacterial pneumonia (45).
The types of neoplasms involving the pleura in the 95 patients are listed in Table 2. The lung and breast were the most common primary sites. In 17
Discussion
The findings of this study confirm the usefulness of closed needle biopsy of the pleura and of cytologic study of pleural fluid in the diagnosis of malignant tumor involving the pleura. Although biopsy or cytology alone yielded definite diagnoses in a relatively high percentage of cases, the two used together provided a diagnosis in 90 percent of the patients.
Considering the focal nature of pleural involvement by metastic tumor, it is not surprising that the success in diagnosis for biopsy
Conclusion
This report has compared the efficacy of pleural needle biopsy and pleural fluid cytopathology in the diagnosis of pleural neoplasm. Cytologic studies alone yielded a higher percentage of cancer diagnoses than did the biopsies alone. A diagnosis was established in 90 percent of the patients with pleural tumor when both studies were performed. These findings indicate the value of utilizing these techniques concomitantly in the evaluation of patients with pleural effusion, which in the adult is
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Cited by (203)
Early Readmission to Hospital in Patients With Cancer With Malignant Pleural Effusions: Analysis of the Nationwide Readmissions Database
2020, ChestCitation Excerpt :Among patients with cancer, MPEs were identified based on codes from a previously published case definition12,14: (1) MPEs as primary diagnosis, (2) MPEs as secondary diagnosis, (3) unspecified pleural effusion as primary diagnosis with a secondary diagnosis of malignancy, and (4) malignancy as primary diagnosis and unspecified effusion as secondary diagnosis. As described by Taghizadeh et al,12 the inclusion of criteria 3 and 4 was felt necessary given the low sensitivity of pleural fluid cytologic examination and the possibility that MPEs with negative cytologic findings would not be coded as such.17,18 To capture all 30-day readmissions, hospital discharges during the month of December were excluded.
Malignancy-Related Effusions
2019, Abeloff’s Clinical OncologyTechniques and strategy of pathological sampling in the diagnostic and therapeutic management of lung cancer
2015, Revue des Maladies RespiratoiresSensitivity and complications of thoracentesis and thoracoscopy: a meta-analysis
2022, European Respiratory Review
Supported by U. S. Public Health Service Training Grant No. GM-00415 and by ELC Grant Nos. NIH-N01-CB92172 and NIH-N01-CN-45037.
Manuscript received June 21; revision accepted September 12.