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Combination of Biochemical and Cytological Findings for Better Diagnosis in Pleural Effusions

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Invasive Diagnostics and Therapy

Part of the book series: Advances in Experimental Medicine and Biology ((CLEXBI,volume 1374))

Abstract

Serous pleural effusions result from increased permeability and changed hydrostatic or colloid osmotic pressure. Laboratory biochemical findings provide conclusions about the effusion compositions. Together with the anamnesis and clinical assessment, they enable the evaluation of the effusion nature. The present study retrospectively analyzed combined biochemical and morphological findings in 2307 effusions of patients from two clinical centers: LungenClinic Grosshansdorf in Germany and Duzce University in Turkey. The effusion cytology results of 1771 and 536 patients from the respective centers were combined with clinical/radiological/biochemical findings and counter compared with the final diagnoses. Cytology verified 738 malignant tumors (643 and 95, respectively). Most effusions were benign (n = 1569; 77%) and 367 of them were paramalignant (293 and 74, respectively) and 594 were inflammatory (465 and 129, respectively). There was a distinctly lower number of malignant tumors in transudates than exudates (87 vs. 725; p < 0.0001). Squamous cell carcinoma was more frequent in paramalignant pleura effusions (122 cases out of the 367 effusions) than pleural carcinomatosis (32 cases out of the 780 malignant tumors; p < 0.0001). The cell formula was a suitable marker for malignant mesothelioma, predominantly mesothelial, or neutrophilic characterized by elevated LDH (>500 U/L) in the early stage of empyema or its late manifestation. İn conclusion, most effusions are benign. Cytologists, assisted by clinical and biochemical data and microscopic findings, can make significant differential diagnostic contributions beyond the sole detection of malignancy.

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Acknowledgments

Hatice Elmas and Christian Biancosino contributed equally to this work.

Conflicts of Interest

The authors declare no conflicts of interest concerning this article.

Ethical Approval

This article was based on a retrospective review of medical files. It does not contain any direct studies or communication with human participants performed by any of the authors. The study was approved by the Ethics Committee of Lübeck University in Germany (permits no. 12-220, 14-225, and 19-181).

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Authors and Affiliations

  1. Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Hatice Elmas, Guido Sauter & Lutz Welker

  2. Department of Thoracic Surgery, HELIOS University Hospital Wuppertal, Wuppertal, Germany

    Christian Biancosino

  3. Department of Pathology and Cytology, School of Medicine, Duzce University, Konuralp Campus, Düzce, Turkey

    Binnur Önal

  4. Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal

    Fernando Schmitt

  5. Medical Faculty, Porto University, Porto, Portugal

    Fernando Schmitt

  6. CINTESIS@RISE, Porto, Portugal

    Fernando Schmitt

  7. Department of Pathology, Mus State Hospital, Mus, Turkey

    Seyma Buyucek

  8. Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Gerhard Nordholt

  9. Airway Research Center North (ARCN), German Center for Lung Research (DZL), Giessen, Germany

    Lutz Welker

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  1. Hatice Elmas
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Correspondence to Christian Biancosino .

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  1. Institute of Health Sciences, Opole University, Opole, Poland

    Mieczyslaw Pokorski

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Elmas, H. et al. (2022). Combination of Biochemical and Cytological Findings for Better Diagnosis in Pleural Effusions. In: Pokorski, M. (eds) Invasive Diagnostics and Therapy. Advances in Experimental Medicine and Biology(), vol 1374. Springer, Cham. https://doi.org/10.1007/5584_2021_703

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