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Introduction: Cases of undiagnosed exudative pleural effusions are common in clinical practice and pose a diagnostic challenge for pulmonologists. Medical thoracoscopy allows both direct visualizations of pleural space for diagnostic evaluation and chemical pleurodesis for therapeutic purposes. Objectives: This study investigated the diagnostic role of medical thoracoscopy in the cases of undiagnosed exudative pleural effusions and complications of thoracoscopic pleural biopsy. Patients and methods: Between December 2016 and August 2019, 195 patients of undiagnosed exudative pleural effusions underwent medical thoracoscopy in our institute. Pleural biopsies were taken and sent for histopathological and microbiological examination. Results: The diagnostic yield of medical thoracoscopy in this study was 89.7%. Definite diagnosis was achieved in 175 out of 195 patients of the study population and only 20 (10.3%) patients were failed to be diagnosed by medical thoracoscopy. Histopathological results of thoracoscopic pleural biopsy among the study population revealed tubercular pleuritis in 31.79% (62 patients), metastatic adenocarcinoma in 23.07% (45 patients), malignant mesothelioma in 18.46% (36 patients), parapneumonic effusions in 6.66% (13 patients), metastatic squamous cell carcinoma in 5.64% (11 patients), small cell carcinoma in 3.07% (6 patients), malignant lymphoma in 0.51% (1 patient), and rheumatoid pleuritis in 0.51% (1 patient). Only 19.4% (38 patients) had minor complications like pain, minor bleeding, subcutaneous emphysema, and re-expansion pulmonary edema. Conclusion: Thoracoscopy is a safe, well-tolerated procedure with minimal risk allowing the accurate diagnosis of undiagnosed pleural effusion. Besides determining the underlying cause, it also provides unique therapeutic approaches like pleurodesis to patients with malignant pleural effusions.
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Soft tissue tumors account for a small percentage of malignancies and synovial sarcomas account for 10% of soft tissue tumors in our body, among them are the synovial sarcomas (SS).These arise from various sites and are of mesenchymal origin, Primary pleural synovial sarcomas are very rare tumours and account for not more than 0.5% of lung malignancies, they are being diagnosed mainly by the immunohistochemistry and classical cytogentic translocation t(x;18). This tumor has no sex preference and is commonly seen in the age group of 30-45.Our case is of a elderly male with massive pleural effusion who was diagnosed as having biphasic variant of synovial sarcoma of pleura by the help of immunohistochemistry. Treatment is mainly surgical resection and chemotherapy with ifosfamide/ adriamycin or radiotherapy. It must be considered as differential for biopsy proven malignant mesothelioma and hence immunohistochemistry should be must for all biopsy proven mesotheliomas.
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Context: Despite recent advances in the available diagnostic modalities, diagnosis of pleural tuberculosis remains a challenge because of the low yield of conventional methods. Pleural biopsy is the gold standard for confirmation of diagnosis, which is invasive and cumbersome. The concentration of mycobacterial peptide-specific activated lymphocytes at the site of infection can be utilized as the basis for using IGRA (interferon-gamma release assays) based evaluation of undiagnosed exudative pleural effusions. Aim: To evaluate the performance of IGRA (Enzyme-linked Immunospot (ELISPOT) in pleural fluid for the diagnosis of pleural tuberculosis in histopathologically confirmed cases. Settings and Design: A prospective observational study compared the utility of ELISPOT with thoracoscopy guided pleural biopsies for the diagnosis of tubercular pleural effusions. Methods and Material: Forty-two consecutive cases of undiagnosed pleural effusions were enrolled and subjected to thoracoscopy guided pleural biopsy. Thirteen patients were confirmed to have tuberculosis, 27 had malignancy, and 2 had normal pleura. A total of 1x103 pleural fluid mononuclear cells (PFMCs) were cultured in the presence of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) for 24 hours. The individual spots were then counted using an automated analyzer ELISPOT reader system. Results: The number of spots developed in the pleural fluid was significantly higher in tubercular pleural effusions as compared to non-tubercular effusions (CFP-10:154.76±14.61 vs 49.24±8.9; ESAT-6: 150.3±17.27 v/s 45.34±8.23, p<0.001). At a cut-off value of more than 67 spots taken as positive for tuberculosis, the sensitivity of the test was 100% (95% CI 75.29% to 100.00%), specificity was 96.5% (95 % CI 82.24% to 99.91%), positive predictive value was 92.86% (95 % CI 65.45% to 98.89%) and negative predictive value was 100%. Conclusions: ELISPOT can be a useful non-invasive test for the evaluation of undiagnosed pleural effusions and making a diagnosis of pleural tuberculosis with confidence.
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Background: Pleural effusion can be treated by antibiotics alone but thoracoscopy assisted debridement has proved superior to antibiotics alone. There is need to study this aspect in more details related to the superiority of the treatment. The objective was to study efficacy of early thoracoscopic debridement for syn-pneumonic pleural effusions in pediatric age group.Methods: A hospital based follow up study was carried out among 40 children of 1-7years of age. They were divided into two groups. One group with 15 children received only antibiotics while the other group with 25 children received thoracoscopic debridement. The results were compared in terms of hospital stay and clinical outcome.Results: It was found that the hospital stay was significantly shorter in children who received thoracoscopic debridement compared to antibiotic group. The chest X-ray was normal in all cases who received thoracoscopic debridement compared to antibiotic group. Decortications were required in five children in antibiotic group compared to none who received thoracoscopic debridement. There was no morbidity and mortality in the children received thoracoscopic debridement. Clinical and symptomatic relief was much better in children received thoracoscopic debridement compared to antibiotic group where there was persistence of the symptoms.Conclusions: Thoracoscopy done in 3days of syn-pneumonic effusions give better out come in terms of hospital stay, morbidity, radiological resolution, compared to thoracocentesis done cases.
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OBJECTIVE:To systematically evaluate therapeutic efficacy and safety of recombinant mutant human tumor necrosis factor(rmhTNF)versus pleural perfusion of cisplatin in the treatment of malignant pleural effusions,and to provide evidence-based reference in clinic. METHODS:Retrieved from PubMed,Cochrane Library,Web of Science,CJFD,Wanfang database,VIP and CBM,RCTs about rmhTNF(trial group)vs. cisplatin(control group)in the treatment of malignant pleural effusions were included. Meta-analysis was conducted by using Rev Man 5.3 statistical software after quality evaluation and data extraction with Cochrane system evaluator manual 5.3.0. RESULTS:A total of 7 RCTs were included,involving 478 patients. Meta-analysis showed that clinical total response rate of trial group [RR=1.43,95%CI(1.27,1.62),P<0.001] was significantly higher than that of control group,with statistical significance. There was no statistical significance in the incidence of gastrointestinal reaction[RR=1.15,95%CI(0.73,1.80),P=0.55],chest pain[RR=1.12,95%CI(0.73,1.73),P=0.60],fever[RR=0.62,95%CI(0.35,1.08),P=0.09] and myelosuppression[OR=0.94,95%CI(0.57,1.54),P=0.79] between trial group and control group. CONCLUSIONS:Pleural perfusion of rmhTNF is significantly better than cisplatin in the treatment of malignant pleural effusions. The incidences of gastrointestinal reaction,chest pain,fever and myelosuppression induced by rmhTNF were similar to those induced by cisplatin.
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Objective To evaluate the efficacy and safety of recombinant human endostatin (rh-endostatin) combined with cis-platinum for patients with malignant pleural effusions.Methods A computer-based online search was performed through Elsevier, PubMed, Medline, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database and Wanfang Database.According to the inclusion and exclusion criteria, the randomized controlled trials about short-term therapeutic effect of rh-endostatin combined with cis-platinum on malignant pleural effusions published until December 2015 were selected.Quality of the studies was assessed using modified Jadad scale.After data extraction, a Meta-analysis was performed by RevMan 5.3 software.Relative risk (RR) and its 95% confidence interval (CI) were calculated.The Egger test was performed by Stata 12.0 software.Results Fourteen eligible randomized controlled trials were included in this Meta-analysis involving 1 330 patients,665 in cis-platinum alone group(control group), and 665 in rh-endostatin combined with cis-platinum group(treatment group).The results showed that there were significant improvements in overall response rate (ORR) [73.53% vs 45.41%,RR=1.62,95%CI(1.47,1.78),P<0.000 01] and the rate of quality of life improvement [71.65% vs 46.94%,RR=1.52,95%CI(1.38,1.68),P<0.000 01] in the treatment group, as compared with those of the control group.Meanwhile, there were no statistically significant differences in the rate of cardio toxicity [10.38% vs 5.77%,RR=1.73,95%CI(0.99,3.03),P=0.06].Conclusion This Meta-analysis indicated that in comparison with cis-platinum alone, rh-endostatin combined with cis-platinum has a better therapeutic effect on malignant pleural effusions.
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Background: Pleural effusions commonly occur in patients with advanced cancer and tuberculosis. Pleural aspiration by the conventional tube thoracostomy using large bore chest tube-intercostal drain (ICD) - can often cause discomfort to patients. The aim of this study is to compare the efficacy of drainage of pleural effusions using flexible small bore Pleural Catheter (PC) and ICD. Methods: In this prospective study, 101 patients (age 16-65 years) with pleural effusions were divided into PC (n=60) and ICD (n=41) groups. Responses were evaluated and analyzed statistically. Results: The PC group was equally efficacious as ICD with regard to complete re-expansion of lung. The most common complication in the PC group was block (9/60 i.e. 15%). Difference in the mean number of days on drain in the PC (4.9 days) and ICD group (5.8 days) as well as the mean number of times analgesics administered in the PC (2.85 days) and the ICD group (7.53 days) were statistically significant (p <0.05). Similarly, the complications such as surgical emphysema, haemorrhage, desaturation and hypotension were high in the conventional group when compared to that of PC group (p <0.05). Conclusions: Flexible small bore intercostal catheter is a valid and safe option for drainage of pleural effusion when compared to the conventional tube thoracostomy.
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Malignant pleural effusions and ascites are common complications in various cancers, which are difficulties in clinical treatment. Elemene injection, with the main ingredient ofβ-elemene, extracted from Chinese herbal medicine Curcumae Rhizoma, has broad-spectrum antitumor activity by inhibiting proliferation and inducing apoptosis in several types of solid tumor cells. This article reviewed the clinical experience of Chinese scholars in treating malignant pleural effusions and ascites with elemene injection.
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ObjectiveTo summarize and review the clinical characteristics of congenital pulmonary lymphangiectasia with fetal bilateral pleural effusions.MethodsThe clinical data of a newborn diagnosed as congenital pulmonary lymphangiec-tasia with bilateral pleural effusions in Obstetrics and Gynecology Hospital, was summarized. The clinical, radiographic features, treatment and prognosis of this case are discussed in the context of the literature review.ResultsThe premature infants present-ed with rapid progression bilateral pleural effusions, respiratory distress, chylothorax, hypoalbuminemia and persistent pulmo-nary hypertension at birth. The pulmonary surfactant was given and mechanical ventilation was used for respiratory support. NO was inhaled, high-frequency mechanical ventilation was applied and albumin was repeatedly administered. After treatment for 3 months in the NICU, the patient was discharged. After 10 days, the patient was administered to the PICU with severe pneumo-nia, chronic lung disease, mechanical ventilation and anti-infection treatments were applied for 2 months. After living for six months, the baby died.ConclusionsCongenital pulmonary lymphangiectasia is extremely rare and prenatal diagnosis was dif-ifcult. The disease should be considered in patients presented with progressive dyspnea, interstitial emphysema after birth. Lung tissue biopsy and radioisotope scanning should be performed in time to get diagnosis.
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Introducción: el tratamiento del derrame pleural maligno constituye un reto para los cirujanos. Su erradicación permanente ha constituido un largo bregar, y para ello se ha utilizado un numeroso grupo de sustancias. Objetivo: mostrar los resultados del uso de diferentes sustancias químicas para conseguir la fusión de las pleuras en el derrame pleural maligno. Métodos: fueron estudiados 116 pacientes con derrames malignos de pleura tratados mediante toracocentesis y escleroterapia química en el Hospital Universitario Comandante Manuel Fajardo entre enero de 2001 y el 2013. El diagnóstico del 100 por ciento de los pacientes fue clínico e imaginológico, con estudio del líquido pleural. Después de la toma de muestra se evacuó todo el contenido mediante un catéter colector y la instilación de la solución esclerosante. Como agentes irritantes se utilizó bleomicina, tetraciclina, amoxicilina y povidona yodada. Resultados: la causa más frecuente de derrame pleural resultó ser el cáncer de mama, seguido por el de pulmón y el ovario. En el hombre fue más frecuente el cáncer de pulmón y en la mujer el cáncer de mama. Predominó el sexo femenino y, específicamente, la sexta década de la vida. El 52,4 por ciento de los pacientes necesitó dos sesiones terapéuticas y el 15,6 por ciento no presentó recidiva después de la primera sesión. Conclusiones: los resultados fueron similares con todas las sustancias utilizadas. La intervención paliativa logró mejorar la calidad de vida al aliviar los síntomas de los pacientes y disminuir la hospitalización(AU)
Introduction: the treatment of the malignant pleural effusion poses a challenge for the surgeons, its permanent eradication has been a long struggle based on the use of a number of substances. Objective: To show the results of the use of different chemical substances to fuse the pleuras in malignant pleural effusion. Methods: one hundred and sixteen patients with malignant pleural effusions, who were treated with thoracentesis and chemical sclerotherapy at Comandante Manuel Fajardo university hospital from January 2001 through January 2013, participated in the study. Their diagnosis was based on clinical examination and imaging, with additional pleural fluid study. After the sample-taking, a collecting catheter and an instilled sclerosing solution were used to remove the whole pleural content, whereas bleomycin, tetracycline, amoxicillin and povidone iodine acted as irritating agents. Results: the most frequent cause of pleural effusion was breast cancer, followed by lung and ovary cancers. The lung cancer was commonest in men and breast cancer in females. Females and the age of 60 years prevailed. In this group, 52.4 por ciento required two therapeutic sessions and 15.6 por ciento showed no relapse after the first session. Conclusions: the results were similar with all the used substances. The palliative intervention succeeded in improving the quality of life, releasing symptoms and reducing hospitalization(AU)
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Humans , Male , Female , Pleural Effusion, Malignant/drug therapy , Sclerosing Solutions/therapeutic use , Thoracoscopy/methodsABSTRACT
Background: Umbilical venous lines are sometimes complicated with pleural and or pericardial effusion, often due to line migration. Case Characteristics: Bilateral chylous pleural effusion without pericardial effusion in a 28 weeks, extremely low birth infant who was on total parenteral nutrition. Observations/Investigations: Investigations including chest x ray and 2D echocardiogram showed bilateral chylous pleural effusions but appropriate tip position of the umbilical venous line. Outcome: Removal of the umbilical venous line and cessation of total parenteral nutrition resulted in complete resolution of the pleural effusion. Message: In any newborn with central venous catheter in situ, acute deteriorations specially, those related to pleural and pericardial effusions should alert the clinicians to remove the catheter and should not be misguided by apparently appearing normal correct catheter position by x-ray or 2D echocardiogram.
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Ultrasound is an alternative technique for the examination of the chest. Recently chest ultrasound has expanded its use mainly on the study of pediatric patients, since it does not use radiation and it is considered by some authors as the first line test in the evaluation of some specific conditions like: superficial lumps and bumps of the chest wall, diaphragm motility, thymus characterization and pleural effusions. The purpose of this paper is to review the main indications for pediatric chest ultrasound in non-cardiac diseases.
El ultrasonido es un examen complementario en el estudio por imágenes del tórax. En los últimos tiempos se ha ampliado su utilización especialmente en el estudio del tórax pediátrico ya que es una alternativa de imagen que no usa radiación y por otra parte, es considerado por algunos autores como el examen de primera línea en la evaluación de algunas patologías específicas como: aumento de volumen superficial de la pared torácica, movimiento diafragmático, timo y derrame pleural. El objetivo de este artículo es revisar las principales indicaciones en el estudio del tórax pediátrico por ultrasonido en patología no cardiológica.
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Child , Thoracic Diseases , Thorax , Ultrasonography , Pleural Cavity , Mediastinum , PediatricsABSTRACT
ObjectiveTo investigate the values of C-reactive protein (CRP) and pleural effusion in predicting the severity in the early stage of severe acute pancreatitis (SAP) . Methods A total of 89patients with acute pancreatitis were collected from October 2008 through October 2010 for retrospective analysis. Patients were divided into two groups, namely mild acute pancreatitis (MAP) group and SAP group as per the Guidelines for Clinical Diagnosis and Classification of Acute Pancreatitis set by the Society of Chinese Medical Association in 2003. The levels of CRP were measured on the 1st, 2nd, 3rd and 7th days after admission. Pleural effusion was also observed on the 1 st day after admission. The data of two groups were analyzed and compared. ResultsThere were significant differences in CRP at all intervals between SAP group and MAP group (P ＜0.05) . The relative risk of increase in CRP ( ＞ 150 mg/L),pleural effusion and increase in CRP along with pleural effusion were analyzed, and each of these three markers can be used as an independent severity factor of SAP. Particularly, increase in CRP along with pleural effusion could be most sensitive in predicting the severity of SAP with relative risk (RR) to be 4. 8 and specificity of predictive value to be 100％. ConclusionsC-reactive protein and pleural effusion are available, simple and economic biomarkers which can help us predict the risk of acute pancreatitis in the early stage.
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Objective To observe the efficacy of Kang'ai Xiaoshui Cream in the treatment of malignant pleural effusions.Methods Forty-three patients with malignant pleural effusions were randomly recruited into a treatment group and a contrast group..The treatment group included 22 cases were treated by Kang'ai Xiaoshui Cream externally,while the contrast group covered 21 cases were treated by IL-2.Results The effective rate of pleural fluid was 63.64%and 57.14% in the treatment group and the contrast group respectively,not showing distinct difference(P>0.05).The positive reactions of pleura adhesion,improvement of life quality,and the adverse reactions of the treatment group were better than contrast group (P<0.05).Conclusion Kang'ai Xiaoshui Cream Can effectively control the malignant pleural effusions and improve the life quality of patients.
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Objective To evaluate the therapeutic effect and possible mechanism of intrapleural administra- tion of cisplatin bound to activated carbon particles for treating malignant pleura] effusions(MPE). Methods ①60 patients with MPE confirmed in the Third Hospital of Changzhou and the Second Hospital of Changzhou from 2004 to 2007 were randomly divided into treatment group (n=30)and control group(n=30). Chest catheters were inserted percutaneously into the pleural space to drain the effusions. Cisplatin mixed with activated carbon particles for the treatment group and only cisplatin for the control group were injected into pleural cavity. Whether above-mentioned treatment should be repeated was determined by ultrasonic B every week until up to four times. Curative effect and side-effect were compared between two groups a month later. ②20 cases, randomly selected from both groups respectively, underwent whole body and chest SPECT scan to image lymphatic system by means of 99Tcm-DX after effusions drainage but before intrapleural injection of drug. Cases whose imaging graphics were abnormal would undergo the above SPECT again 2 weeks after intrapleural injection of drug so as to find changes in imaging graphics. Results ① The overall response rate was significantly higher in treatment group than in control group(100% (30/30) vs 66.7% (20/30), χ2=12.00, P<0.01)and that intrapleural injection was needed only once in most cases. Gastrointestinal upset and leucoponia were less and milder in treatment group than in control group (16.7% (5/30) vs 30.0% (9/30) and 6.7% (2/30) vs 20.0% (6/30) respectively),but there was no statistical difference between the two groups(χ2=1.49 and 1.30,P>0.05). ②The rate of improvement in lymphatic imaging was significantly higher in treatment group than in control group (78.6% (11/14) vs 37.5% (6/16),P<0.05). Conclusion The treatment of malignant pleural effusions with intrapleural administration of cisplatin bound to activated carbon particles is extremely effective and safe, and can improve lymphatic drainage as well.
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Objective To evaluated the efficacy of lentinan injection and carboplatin for malignant pleural effusions.Methods 63 patients were divided into the experimental group and control group.The experimental group were adminstered lentinan injection and carboplatin.Results The response rate of the experimental group was 81.2%,the control group was 61.3%.The better quality of life appeared in the experimental group.Conclusion Postoperative lentinan injection and carboplatin in formalignant pleural effusions is a beneficial therapeusis that helps to improve survival rates and qulity of life.
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Objective: To investigate the association of nuclear DNA content and vascular endothelial growth factor (VEGF) and p53 expression with therapeutic response of malignant pleural effusion and their value in predicting the prognosis of wet lung cancer. Methods: The survival periods of 43 lung cancer patients with pleural effusions were followed up. The DNA content of 39 patients was measured by the image cytometry (ICM) and the expression of VEGF and p53 was determined by Envision immunohistochemical method. Twenty-nine patients were given bleomycin or interleukin-2 intrathoracically after drainage. Results: DNA aneuploid had a tendency to correlate with therapeutic efficacy of malignant pleural effusion (P = 0. 054). Cox multivariate analysis showed that only p53 expression was independent prognostic factor for lung patients with pleural effusion (P = 0.05). The median survival time of patients was (10.4 ± 3.5) months for p53-negative patients and (2.8 ± 0.6) months for p53-positive patients (log rank = 0.013 2). One-year survival rate was 17.7% for p53-negative patients and 0% for p53-positive patients. Conclusion: DNA content measured by ICM tended to correlate with the therapeutic efficacy of malignant pleural effusion; p53 expression is a unique independent prognostic factor for lung cancer patients with pleural effusions.
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Objective To evaluate the efficacy and adverse effects of bleomycin combined with Interleukin-2 for malignant pleural effusions in patients with NSCLC. Methods Malignant pleural effusions were excreted cleanly from indwelling chest tube, bleomycin and Interleukin-2 were injected thorax. Results Total survival rate is 88.5 %, only part patients have fever, chest pain, tetter, nausea. Conclusion Bleomycin combined with Interleukin-2 treat patients with malignant pleural effusion from NSCLC, the efficacy are better, the adverse effects are tolerabe.
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Tradicionalmente, la pleurodesis se ha empleado en enfermos con neoplasias malignas confirmadas y esperanza razonable de sobrevida, complicados con derrame pleural recurrente de más de la mitad del hemitórax, con disnea que mejora con la evacuación del líquido, un pulmón que puede expandirse hasta la pared torácica y la expectativa de un periodo de sobrevida razonable. La evacuación del líquido y la inducción de esclerosis pleural se puede intentar en la cama del enfermo, o en el cubículo de urgencias con un catéter fino o una sonda de mayor diámetro, en una sala de procedimientos por toracoscopía de un acceso con anestesia local y sedación, o bien, en un quirófano con anestesia general por videotoracoscopía, introduciendo sustancias esclerosantes y/o realizando diversos tipos de abrasión sobre las pleuras parietal y visceral. Se propone el empleo de pleurodesis cerrada de primera intención con un catéter pleural o vascular que sirve para evacuar todo el líquido e introducir el agente esclerosante, en enfermos con neoplasias malignas que cursen con derrame pleural de más de la mitad del hemitórax, con disnea o sin ella, y esperanza razonable de sobrevida; según el caso particular, el catéter se puede extraer, previo control radiográfico, dejarlo para repetir la pleurodesis varios días y luego retirarlo o, si falla la pleurodesis, dejarlo in situ para drenar el tórax con una jeringa cada vez que sea necesario, sin preocuparse ya por buscar la pleurodesis en estos enfermos afectados por una neoplasia terminal, y que desean vivir sin disnea los días que les quedan de vida; el procedimiento no es oneroso, se realiza sin necesidad de hospitalización, no requiere sonda torácica ni drenaje pleural y es efectivo en el 90% de los enfermos. El consenso de la información actual no aconseja la pleurectomfa parietal como procedimiento de elección.
Traditionally, pleurodesis has been attempted in patients with confirmed malignant tumors with recurring pleural effusions of more than half the size of the hemithorax, dyspnea that is relieved by evacuation of the fluid, a lung able to reach the chest wall and the expectation of a reasonably long survival period. Pleurodesis can be done at the bedside, the emergency room, in a procedure room by medical thoracoscopy under local anesthesia and sedation, or in the operating room by VATS under general anesthesia, introducing an sclerosing agent and/or producing pleural abrasion by different means. We propose "first contact closed pleurodesis " for patients with an unequivocal diagnosis of malignancy, a pleural effusion of more than half the size of the hemithorax, even if asymptomatic, and the expectation of a reasonably long survival period, using a vascular or pleural catheter to drain the fluid and introduce the sclerosing substance; depending on the chest x-ray, the catheter can be pulled out, left in situ to repeat the introduction of the sclerosing agent or, if this fails, to drain the fluid as often as necessary with a sterile syringe, ignoring the goal to achieve pleurodesis; the procedure is effective in over 90% of cases and non-expensive, can be done on an outpatient basis and does not require a chest tube nor a pleural drainage system. Present day consensus does not support parietal pleurectomy as an elective choice for these patients.
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BACKGROUND: The purpose of this study was to evaluate the usefulness of the pleural fluid carcinoembryonic antigen (CEA) and cytokeratin fragment 19 (CYFRA 21-1) tumor markers as complementary tools for the diagnosis of malignant pleural effusions. PATIENTS AND METHODS: The levels of pleural and serum CEA and CYFRA 21-1 were prospectively assayed in 222 patients with pleural effusions (150 benign effusions, 57 bronchogenic carcinomas and 15 metastatic carcinomas). RESULTS: The levels of pleural fluid CEA and CYFRA 21-1 in the malignant effusions were significantly higher than those in the benign effusions. With a specificity of 95%, the cut off values for the CEA and CYFRA 21-1 in pleural effusions were 5 and 89 ng/ml, respectively. The diagnostic sensitivities of the pleural fluid CEA and CYFRA 21-1 in malignant effusions were 72 and 54%, respectively, whereas using a combination of the two, the sensitivity increased to 87% (p<0.05). CONCLUSIONS : These findings suggest that a combination of the pleural fluid CEA and CYFRA 21-1 in pleural effusions can be useful in the diagnosis of malignant pleural effusions.