Evaluation of Exudative Pleural Effusions: A Multicenter, Prospective, Observational Study.

Autor: Ak G; Medical Faculty, Department of Chest Diseases, Eskisehir Osmangazi University, Eskisehir, Turkey. guntuluak@gmail.com., Metintas S; Medical Faculty, Department of Public Health, Eskisehir Osmangazi University, Eskisehir, Turkey., Taskın AN; Department of Chest Diseases, University of Health Sciences Turkey, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey., Uzel Sener M; Department of Chest Diseases, University of Health Sciences Turkey, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey., Soyler Y; Department of Chest Diseases, University of Health Sciences Turkey, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey., Yilmaz M; Medical Faculty, Department of Chest Diseases, Namik Kemal University, Tekirdaǧ, Turkey., Turna A; Department of Thoracic Surgery, Cerrahpasa Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey., Akin Kabalak P; Department of Chest Diseases, University of Health Sciences Turkey, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey., Bilaceroglu S; Department of Pulmonary Medicine, University of Health Sciences Turkey, Izmir Dr Suat Seren Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey., Koksal D; Medical Faculty, Department of Chest Diseases, Hacettepe University, Ankara, Turkey., Yilmaz Demirci N; Medical Faculty, Department of Chest Diseases, Gazi University, Ankara, Turkey., Sogukpinar O; Department of Chest Diseases, University of Health Sciences Turkey, Sureyyapasa Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey., Boga S; Department of Chest Diseases, University of Health Sciences Turkey, Sureyyapasa Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey., Ercelik M; Medical Faculty, Department of Chest Diseases, Duzce University, Duzce, Turkey., Karadeniz G; Department of Pulmonary Medicine, University of Health Sciences Turkey, Izmir Dr Suat Seren Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey., Polat G; Department of Pulmonary Medicine, University of Health Sciences Turkey, Izmir Dr Suat Seren Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey., Guldaval F; Department of Pulmonary Medicine, University of Health Sciences Turkey, Izmir Dr Suat Seren Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey., Aka Akturk U; Department of Chest Diseases, University of Health Sciences Turkey, Sureyyapasa Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey., Yilmaz S; Medical Faculty, Department of Chest Diseases, Eskisehir Osmangazi University, Eskisehir, Turkey., Ogan N; Medical Faculty, Department of Chest Diseases, Ufuk University, Ankara, Turkey., Yilmaz S; Department of Chest Diseases, University of Health Sciences Turkey, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey., Esendagli D; Medical Faculty, Department of Chest Diseases, Baskent University, Ankara, Turkey., Caglayan B; Medical Faculty, Department of Chest Diseases, Koc University, Istanbul, Turkey., Zeybek A; Medical Faculty, Department of Thoracic Surgery, Mugla Sitki Kocman University, Mugla, Turkey., Durmus Kocak N; Department of Chest Diseases, University of Health Sciences Turkey, Sureyyapasa Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey., Mutlu P; Medical Faculty, Department of Chest Diseases, Canakkale Onsekiz Mart University, Canakkale, Turkey., Atinkaya Baytemir C; Hamidiye Faculty of Medicine, Department of Thoracic Surgery, University of Health Sciences Turkey, Istanbul, Turkey., Sarbay I; Department of Thoracic Surgery, Cerrahpasa Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey., Yilmaz U; Department of Chest Diseases, University of Health Sciences Turkey, Ankara Atatürk Sanatory Education and Research Hospital, Ankara, Turkey., Metintas M; Medical Faculty, Department of Chest Diseases, Eskisehir Osmangazi University, Eskisehir, Turkey.
Jazyk: angličtina
Zdroj: Lung [Lung] 2022 Dec; Vol. 200 (6), pp. 807-815. Date of Electronic Publication: 2022 Sep 29.
DOI: 10.1007/s00408-022-00573-8
Abstrakt: 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.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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