International Society For Minimally Invasive Cardiothoracic Surgery

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A Comparison Of The Diagnostic Yield Of Pleural Fluid Cytology With Biopsy Specimens (histology) In Patients With Malignant Pleural Effusion
Abdullah Albahar, Faisal Alshlahi, Alan Kirk.
University of Glasgow, Glasgow, United Kingdom.

Background: The main objective of this study is to determine the diagnostic yield of pleural fluid cytology when compared with biopsy specimens in regards to the detection of malignant pleural effusions. This project will also allow us to discuss the limitations of cytology as it is applied to the diagnosis of cancer, and to evaluate whether this technique improves diagnostic accuracy.Methods:Data was collected from a single centre through the clinical portal. This included medical records from 74 consecutive patients with suspected pleural effusions due to malignancy. Cases that underwent pleural fluid cytology were reviewed and results from both cytology and pleural biopsy were recorded. There were 51 (72%) men and 23 (28%) women with a median age of 78.9 years (range 18 - 88 years).Results:A total of 74 patients (68 of which had undergone pleural biopsy and 65 cytology) were included in the study. Overall, 42 out of the 68 patients (61.8%) were diagnosed by histology. 0% were considered to have an indeterminate diagnosis or not enough sample to determine a diagnosis. Cytology was able to diagnose 17 out of the 65 patient sample (26.2%). 3.0% and 29.2% were however categorised as having ‘not enough sample' and ‘indeterminate diagnosis' respectively. Overall, 59 patients had both pleural biopsy and cytology carried out. 13 out of 59 (22%) patients resulted in a positive outcome (concordance) between both histology and cytology. However, 24 out of 59 patients (40.7%) exhibited discordance between both results (positive for histology and either a negative or indeterminate diagnosis for cytology).Conclusion:The project shows that overall diagnostic yield favours that of pleural biopsy. We conclude that cytological evaluation of pleural fluid might be of benefit if used as an initial investigation, however, it is of no diagnostic value if a biopsy specimen is available.

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