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Predicting Malignant and Paramalignant Pleural Effusions by Combining Clinical, Radiological and Pleural Fluid Analytical Parameters

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Abstract

Background

The usefulness of clinical, radiological and pleural fluid analytical parameters for diagnosing malignant and paramalignant pleural effusion is not clearly stated. Hence this study aimed to identify possible predictor variables of diagnosing malignancy in pleural effusion of unknown aetiology.

Methods

Clinical, radiological and pleural fluid analytical parameters were obtained from consecutive patients who had suffered pleural effusion of unknown aetiology. They were classified into three groups according to their final diagnosis: malignant, paramalignant and benign pleural effusion. The CHAID (Chi-square automatic interaction detector) methodology was used to estimate the implication of the clinical, radiological and analytical variables in daily practice through decision trees.

Results

Of 71 patients, malignant (n = 31), paramalignant (n = 15) and benign (n = 25), smoking habit, dyspnoea, weight loss, radiological characteristics (mass, node, adenopathies and pleural thickening) and pleural fluid analytical parameters (pH and glucose) distinguished malignant and paramalignant pleural effusions (all with a p < 0.05). Decision tree 1 classified 77.8% of malignant and paramalignant pleural effusions in step 2. Decision tree 2 classified 83.3% of malignant pleural effusions in step 2, 73.3% of paramalignant pleural effusions and 91.7% of benign ones.

Conclusions

The data herein suggest that the identified predictor values applied to tree diagrams, which required no extraordinary measures, have a higher rate of correct identification of malignant, paramalignant and benign effusions when compared to techniques available today and proved most useful for usual clinical practice. Future studies are still needed to further improve the classification of patients.

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Abbreviations

BPE:

Benign pleural effusion

CEIC:

Committee of ethics and clinical trials

CHAID:

Chi-square automatic interaction detector

CI:

Confidence intervals

CT:

Computed tomography

LDH:

Lactate dehydrogenase

pH:

Potential of hydrogen

MPE:

Malignant pleural effusion

PPE:

Paramalignant pleural effusion

SD:

Standard deviation

References

  1. Villena Garrido V, Cases Viedma E, Fernández Villar A, de Pablo Gafas A, Pérez Rodríguez E, Porcel Pérez JM et al (2014) Normativa sobre el diagnóstico y tratamiento del derrame pleural. Actualización. Arch Bronconeumol 50:235–249

    Google Scholar 

  2. Thomas JM, Musani AI (2013) Malignant pleural effusions: a review. Clin Chest Med 34:459–471

    Article  PubMed  Google Scholar 

  3. Heffner JE, Nietert PJ, Barbieri C (2000) Pleural fluid pH as a predictor of survival for patients with malignant pleural effusions. Chest 117:79–86

    Article  CAS  PubMed  Google Scholar 

  4. Gonzalez AV, Bezwada V, Beamis JF Jr, Villanueva AG (2010) Lung injury following thoracoscopic talc insufflation: experience of a single North American center. Chest 137:1375–1381

    Article  PubMed  Google Scholar 

  5. Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ (2010) Management of a malignant pleural effusion: British thoracic society pleural disease guideline 2010. Thorax 65:32–40

    Article  Google Scholar 

  6. Cantó A, Ferrer G, Romagosa V, Moyya J, Bernat R (1985) Lung cancer and pleural effusion: clinical significance and study of pleural metastatic locations. Chest 87:649–652

    Article  PubMed  Google Scholar 

  7. Le Roux BT (1968) Bronchial carcinoma. E&S Livingstone, Edinburgh, pp 127–130

    Google Scholar 

  8. Anthony VB, Loddenkemper R, Astoul P, Boutin C, Goldstraw P, Hott J et al (2001) ERS/ATS Statement. Management of malignant pleural effusions. Eur Respir J 18:402–419

    Article  Google Scholar 

  9. Villena Garrido V, Ferrer Sancho J, Hernández Blasco L, de Pablo Gafas A, Pérez Rodríguez E, Rodríguez Panadero F et al (2006) Diagnóstico y tratamiento del derrame pleural. Arch Bronconeumol 42:349–372

    Article  PubMed  Google Scholar 

  10. Light RW, MacGregor MI, Luchsinger PC, Ball WC Jr (1972) Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 77:507–513

    Article  CAS  PubMed  Google Scholar 

  11. Garcia L (1994) The value of multiple fluid specimens in the cytological diagnosis of malignancy. Mod Pathol 7:665–668

    CAS  PubMed  Google Scholar 

  12. American Thoracic Society (2000) Management of malignant pleura effusions. Am J Respir Crit Care Med 162:1987–2001

    Article  Google Scholar 

  13. Yohannes Y, Hoddinott J (1999) Classification and regression trees: an introduction. International Food Policy Research Institute, Washington, DC, USA. Available at: http://pdf.usaid.gov/pdf_docs/PNACH725.pdf

  14. Lewis RJ. An introduction to classification and regression tree (CART) analysis. In Annual Meeting of the society for academic emergency medicine; San Francisco, CA, USA. 2000; 1–14

  15. Biggs D, De Ville B, Suen E (1991) A method of choosing multiway partitions for classification and decision trees. J Appl Stat 18:49–62

    Article  Google Scholar 

  16. Valdés L, San-José E, Ferreiro L, Golpe A, González-Barcala FJ, Toubes ME et al (2015) Predicting malignant and tuberculous pleural effusions through demographics and pleural fluid analysis of patients. Clin Respir J 9:203–213

    Article  PubMed  Google Scholar 

  17. Valdés L, San-José E, Ferreiro L, González-Barcala FJ, Golpe A, Álvarez-Dobaño JM et al (2013) Combining clinical and analytical parameters improves prediction of malignant pleural effusion. Lung 191:633–643

    Article  PubMed  Google Scholar 

  18. Ferrer J, Roldán J, Teixidor J, Pallisa E, Gich I, Morell F (2005) Predictors of pleural malignancy in patients with pleural effusion undergoing thoracoscopy. Chest 127:1017–1022

    Article  PubMed  Google Scholar 

  19. Porcel JM, Pardina M, Bielsa S, González A, Light RW (2015) Derivation and validation of a CT scan scoring system for discriminating malignant from benign pleural effusions. Chest 147:513–519

    Article  PubMed  Google Scholar 

  20. Sahn SA, Good JT Jr (1988) Pleural fluid pH in malignant effusions: diagnostic, prognostic, and therapeutic implications. Ann Intern Med 108:345–349

    Article  CAS  PubMed  Google Scholar 

  21. Heffner JE, Nietert PJ, Barbieri C (2000) Pleural fluid pH as a predictor of pleurodesis failure: analysis of primary data. Chest 117:87–95

    Article  CAS  PubMed  Google Scholar 

  22. Hooper C, Lee YCG, Maskell N (2010) Investigation of a unilateral pleural effusion in adults: British thoracic society pleural disease guideline 2010. Thorax 65(Suppl 2):ii4–ii17

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the Pulmonology Foundation of the Valencian Community for the grant awarded to conduct this study. They would also like to thank everyone who has collaborated either directly or indirectly in this research.

Funding

Dr. Herrera Lara has received research scholarship support from the Pulmonology Foundation of the Valencian Community.

Author Contribution

Dr. Herrera Lara, corresponding author, designed and performed research, collected, analysed and interpreted data, wrote the manuscript. Dr. Fernández Fabrellas designed and performed research, interpreted data, wrote the manuscript, revised the article critically. Dr. Juan Samper revised the article critically. Dr. Marco Buades analysed and interpreted data. Dr. Andreu Lapiedra analysed and interpreted data. Mrs. Pinilla Moreno provided technical assistance. Dr. Morales Suárez-Varela analysed and interpreted data, performed statistical analysis, revised the article critically. All authors have approved the final version of paper for submission.

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Authors and Affiliations

  1. Pulmonology Department, Dr Peset University Hospital, Avenue Gaspar Aguilar, 90, 46017, Valencia, Spain

    Susana Herrera Lara

  2. Pulmonology Department, General University Consorci Hospital, Valencia, Spain

    Estrella Fernández-Fabrellas & Gustavo Juan Samper

  3. Hematology Department, Dr Peset University Hospital, Valencia, Spain

    Josefa Marco Buades & Amparo Pinilla Moreno

  4. Hematology Department, La Fe University and Polytechnic Hospital, Valencia, Spain

    Rafael Andreu Lapiedra

  5. Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain

    María Morales Suárez-Varela

  6. Biomedical Research Centre Network on Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain

    María Morales Suárez-Varela

  7. Center for Public Health Research (CSISP-FISABIO), Valencia, Spain

    María Morales Suárez-Varela

Authors
  1. Susana Herrera Lara
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  2. Estrella Fernández-Fabrellas
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  3. Gustavo Juan Samper
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  4. Josefa Marco Buades
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  5. Rafael Andreu Lapiedra
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  6. Amparo Pinilla Moreno
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  7. María Morales Suárez-Varela
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Corresponding author

Correspondence to Susana Herrera Lara.

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Herrera Lara, S., Fernández-Fabrellas, E., Juan Samper, G. et al. Predicting Malignant and Paramalignant Pleural Effusions by Combining Clinical, Radiological and Pleural Fluid Analytical Parameters. Lung 195, 653–660 (2017). https://doi.org/10.1007/s00408-017-0032-3

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  • DOI: https://doi.org/10.1007/s00408-017-0032-3

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