Abstract
Purpose
The aim of this study is to determine the diagnostic performances of pleural procedures in undiagnosed exudative pleural effusions and to evaluate factors suggestive of benign or malignant pleural effusions in tertiary care centers.
Methods
This was a multicenter prospective observational study conducted between January 1 and December 31, 2018. A total of 777 patients with undiagnosed exudative pleural effusion after the initial work-up were evaluated. The results of diagnostic procedures and the patients' diagnoses were prospectively recorded. Sensitivity, specificity, and accuracy estimates with 95% confidence intervals were used to examine the performance of pleural procedures to detect malignancy.
Results
The mean age ± SD of the 777 patients was 62.0 ± 16.0 years, and 68.3% of them were male. The most common cause was malignancy (38.3%). Lung cancer was the leading cause of malignant pleural effusions (20.2%). The diagnostic sensitivity and accuracy of cytology were 59.5% and 84.3%, respectively. The diagnostic sensitivity of image-guided pleural biopsy was 86.4%. The addition of image-guided pleural biopsy to cytology increased diagnostic sensitivity to more than 90%. Thoracoscopic biopsy provided the highest diagnostic sensitivity (94.3%). The highest diagnostic sensitivity of cytology was determined in metastatic pleural effusion from breast cancer (86.7%).
Conclusion
The diagnostic performance increases considerably when cytology is combined with image-guided pleural biopsy in malignant pleural effusions. However, to avoid unnecessary interventions and complications, the development of criteria to distinguish patients with benign pleural effusions is as important as the identification of patients with malignant pleural effusions.
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Acknowledgements
The study was supported by Turkish Respiratory Society. We thank Turkish Respiratory Society Pleura Study Group and Young Academicians Group.
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GA, CAB, BC, SB, and DK contributed to the study conception and design. GA, ANT, MUS, YS, MY, AT, PAK, SB, DK, NYD, OS, SB, ME, GK, GP, FG, UAA, SY, NO, SY, DE, BC, AZ, NDK, PM, IS and MM collected data. SM analysed data. GA wrote the first draft of the manuscript and all authors commented on previous versions of the manuscript. GA, SB, UY and MM edited the manuscript. All authors read and approved the final manuscript.
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Ak, G., Metintas, S., Taskın, A.N. et al. Evaluation of Exudative Pleural Effusions: A Multicenter, Prospective, Observational Study. Lung 200, 807–815 (2022). https://doi.org/10.1007/s00408-022-00573-8
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DOI: https://doi.org/10.1007/s00408-022-00573-8