Can suspicion for malignancy improve the indication of video-assisted thoracoscopic surgery (VATS) in patients with pleural effusion of unknown cause?
| Autor: | Queralt Jordano Montañez, Angels Jaen Manzanera, Ramon Rami Porta, Bienvenido Barreiro Lopez, Lydia Canales Aliaga, Tommaso Francesco Aiello |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
business.industry Pleural effusion medicine.medical_treatment Retrospective cohort study 030204 cardiovascular system & hematology Malignancy medicine.disease Pericardial effusion respiratory tract diseases 03 medical and health sciences 0302 clinical medicine 030228 respiratory system Video-assisted thoracoscopic surgery medicine Etiology Malignant pleural effusion Medical history Radiology business |
| Zdroj: | Pleural and Mediastinal Malignancies. |
| DOI: | 10.1183/1393003.congress-2017.pa4297 |
| Popis: | Introduction: VATS is the investigation of choice for pleural effusions when diagnostic thoracentesis is inconclusive, with sensitivity rates of approximately 95% for malignancy. Nevertheless, in about half of the patients undergoing VATS, pleural biopsy does not demonstrate malignancy. Objectives: to describe the efficiency of VATS in the workup of pleural effusions of unknown etiology in our setting and to identify clinical, radiological and biochemical parameters allowing differentiation between malignant and non-malignant pleural effusions. Methods: retrospective study of patients with pleural effusion who underwent VATS for diagnostic purposes, between 2005 and 2016 at Hospital Universitari Mutua Terrassa. We considered demographic data, medical history, clinical symptoms, radiological features and pleural fluid analysis. Results: 117 patients were included; 78 (67%) men; mean age 69 years (SD 14). VATS demonstrated malignancy in 58 patients (49.6%). Variables associated with malignancy included younger age (66.5 vs 72, p = 0.03), symptomatic period ≥ 1 month (77% vs 55%, p = 0.02), presence of pulmonary or pleural masses on chest CT (60% vs 27%, p = 0.000), and higher LDH pleural fluid levels (796 vs 586, p = 0.003). Bilateral effusions (10.5 % vs 34%, p= 0.03) and presence of pericardial effusion (3.5% vs 24%, p = 0.002) were associated with non-malignant pleural effusions. Conclusions: VATS demonstrated malignancy in nearly half of the patients. Younger age, symptomatic period ≥ 1 month, pulmonary or pleural masses on chest CT and higher LDH pleural fluid levels were more frequent among patients with malignant pleural effusion. |
| Databáze: | OpenAIRE |
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