Abstract
Introduction: Management of pleural effusion is based on established guidelines deriving from scientific committees and experts on pleural diseases all over the world. Nevertheless true consensus on volume sampling in malignant pleural effusions has not yet been achieved. Only few publications have been published over the past 10 years. Further studies should take place in order to clarify this essential point in the management of malignant pleural effusions.
Hypothesis: 20 to 40 ml of pleural fluid could improve cytology yield in high risk malignancy patients.
Methods and Materials: Patients with at least medium sized pleural effusion and high risk for malignancy are enrolled.
Pleural fluid is extracted as follows:
1. 10cc of pleural fluid sent for cell typing and ALB, tPr, LDH, CHOL, TG analysis
2. 20cc of pleural fluid extracted and placed as sample A
3. 50cc of pleural fluid extracted and placed as sample B
4. 150cc of pleural fluid should be extracted and placed as sample C
Samples A, B and C are sent for cytology
Cytology results include the following:
1. Positivity or negativity for malignancy
2. Malignant cells numerosity (rare, infrequent, frequent, dense)
First data in our research strongly support our hypothesis and we feel that with our sample growing we will be able to show that a larger quantity of pleural fluid will not improve results (whilst will affect costs and laboratory man hours), but 20 to 40 ml could play a role in diagnosis and should be the target quantity. We hope our study will help to decrease time to diagnosis, reduce cost (less paracentesis, less adverse effects, less hospitalization time) and provide material for evidence based guideline development in the future.
- © 2012 ERS