Publish in this journal
Journal Information
Vol. 54. Num. 6.June 2018
Pages 301-354
Share
Share
Download PDF
More article options
ePub
Visits
3
Vol. 54. Num. 6.June 2018
Pages 301-354
Original Article
DOI: 10.1016/j.arbr.2018.01.019
Detection of Pleural Fluid Biochemistry Changes in Two Consecutive Thoracenteses for Differentiating Malignant From Benign Effusions
Cambios en los parámetros bioquímicos del líquido pleural entre 2 toracocentesis consecutivas para diferenciar derrames malignos de benignos
Visits
3
Silvia Bielsaa, Alberto García-Zamalloab, Paula Monteagudoa, Didac González-Sansc, David Ascaniod, Aureli Esquerdae, Jorge Taboada-Gómezf, José M. Porcela,
Corresponding author
jporcelp@yahoo.es

Corresponding author.
a Unidad de Medicina Pleural, Hospital Universitario Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
b Servicio de Medicina Interna, Hospital de Mendaro, Mendaro, Gipuzkoa, Spain
c Servicio de Medicina Interna, Hospital Universitario Vall d’Hebrón, Barcelona, Spain
d Facultad de Medicina, Universitat de Lleida, Lleida, Spain
e Servicio de Análisis Clínicos, Hospital Universitario Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
f Servicio de Medicina Preventiva y Salud Pública, Hospital de Urdúliz-Alfredo Espinosa, Urduliz, Vizcaya, Spain
This item has received
3
Visits
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Tables (6)
Table 1. Characteristics of the Study Population.
Table 2. Comparison of Pleural Fluid Variables Between 2 Consecutive Thoracenteses (Derivation Population).
Table 3. Medians (25th and 75th Percentiles) of the Absolute and Percentage Differences of Biochemical Variables of Pleural Fluid Between Two Successive Thoracenteses (Derivation Population).
Table 4. Operational Characteristics of Absolute and Percentage Differences in Different Biochemical Parameters of Pleural Fluid for Discriminating Malignant Effusions From Benign Effusionsa (Derivation Population).
Table 5. Operational Characteristics of Absolute and Percentage Differences in Different Biochemical Parameters of Pleural Fluid for Discriminating Malignant Effusions From Idiopathic Effusionsa (Derivation Population).
Table 6. Operational Characteristics of Absolute and Percentage Differences in Different Biochemical Parameters of Pleural Fluid for Discriminating Malignant Effusions From Benign Effusionsa (Validation Population).
Show moreShow less
Abstract
Objective

To assess whether changes in pleural fluid (PF) biochemistries between two consecutive thoracenteses enable clinicians to predict malignant or benign pleural effusions (PE).

Methods

Retrospective study of patients with lymphocytic exudates and negative PF cytology, who underwent a second thoracentesis in our center in the last 15 years in whom a final diagnosis was reached (derivation sample). Absolute (Δa) and percentage differences (Δp) in PF biochemistries which predicted a malignant or benign PE in the derivation sample were evaluated in an independent population (validation sample).

Results

The derivation sample included 214 PE patients (70 malignant and 144 benign PE). Δp lactate dehydrogenase (LDH)>0%, Δp neutrophils>−10% (any increase or less than 10% decrease) and Δa protein <0.1g/dL (any increase or less than 0.1g/dL decrease) between the second and the first thoracentesis had an odds ratio of 6.4, 3.9 and 2.1, respectively, to discriminate malignant from benign PE. The presence of the three conditions together had a positive likelihood ratio of 5.6, whereas the absence of any of the three parameters had a likelihood ratio of 0.04 for predicting malignancy. These results were reproduced in the validation sample.

Conclusion

An increase in LDH and neutrophils along with a decrease in protein in a second thoracentesis increase the probability of malignant PE, while the opposite reduces it significantly.

Keywords:
Malignant pleural effusion
Thoracentesis
Pleural fluid
Lactate dehydrogenase
Resumen
Objetivo

Evaluar si los cambios en los parámetros bioquímicos del líquido pleural (LP) entre 2 toracocentesis sucesivas permiten predecir derrames pleurales (DP) malignos o benignos.

Métodos

Estudio retrospectivo de los pacientes con exudado linfocitario y citología negativa para malignidad que se sometieron a una segunda toracocentesis en nuestro centro durante los últimos 15 años (muestra de derivación), y en los que se alcanzó un diagnóstico final. Las diferencias absolutas (Δa) o porcentuales (Δp) de diferentes parámetros bioquímicos del LP capaces de predecir la naturaleza maligna o benigna del DP en la muestra de derivación se evaluaron en una población independiente.

Resultados

Se incluyeron 214 pacientes con DP (70 malignos y 144 benignos) en la muestra de derivación. Las Δp LDH (lactato deshidrogenasa) > 0%, Δp neutrófilos > –10% (cualquier aumento o bien un descenso inferior al 10%), y Δa proteínas < 0,1g/dL (cualquier descenso o bien un aumento inferior a 0,1g/dL) entre la segunda y primera toracocentesis mostraron unas odds ratio de 6,4, 3,9 y 2,1 para discriminar DP maligno de benigno, respectivamente. La presencia de las 3 condiciones conjuntamente se asoció con una likelihood ratio positiva de 5,6, mientras que la ausencia de cualquiera ellas se asoció con una likelihood ratio negativa de 0,04 para predecir malignidad. Los resultados se reprodujeron en la población de validación.

Conclusión

El aumento de LDH y neutrófilos, junto con el descenso de proteínas en una segunda toracocentesis, aumenta la probabilidad de que el origen del DP sea neoplásico, mientras que lo contrario la reduce significativamente.

Palabras clave:
Derrame pleural maligno
Toracocentesis
Líquido pleural
Lactato deshidrogenasa

Article

These are the options to access the full texts of the publication Archivos de Bronconeumología (English Edition)
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Archivos de Bronconeumología (English Edition)

Contact
Telephone
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
902 88 87 40
Calls from outside Spain
+34 932 418 800
E-mail
Idiomas
Archivos de Bronconeumología (English Edition)

Subscribe to our Newsletter

Article options
Tools
es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?