ABSTRACT
CONTEXT: A good proportion of patients with undiagnosed pleural effusion (PE) turn into malignancy over a period of time. Identification of positive biomarker may help in selecting the individuals who require close follow-up. AIMS: The aims of this study were to evaluate the role of DR-70 immunoassay in suspected malignant PE. SETTINGS AND DESIGN: We conducted a cross-sectional study among 89 patients of suspected malignant PE and 50 normal subjects (NS) were taken as control. MATERIALS AND METHODS: Patients with exudative PE; who had pleural fluid lymphocyte count greater than 50% and adenosine deaminase less than 30 U/L were taken as cases. We had selected NSs among relatives of patients having normal blood chemistry and radiological investigations. Sensitivity and specificity of the test to differentiate malignant and non-malignant PE and also to identify PE with underlying malignancy was analyzed. RESULTS: Mean value of DR-70 in NS was found to be 0.83 ± 0.273 mg/L without any significant difference between males (0.82 mg/L) and females (0.85 mg/L). Mean value of DR-70 in PE with underlying cancer was 5.03 ± 3.79 mg/L. Sensitivity (80%) and specificity (77.78%) of the test was maximum in PE with underlying cancer using cut-off value of 2 mg/L. Mean value DR-70 in malignant PE was 5.18 ± 3.75 mg/L and in non-malignant PE was 3.73 ± 3.74 mg/L without any statistically significant difference (P = 0.08). CONCLUSIONS: DR-70 assay has high sensitivity in detecting underlying lung cancer, but has no role in differentiating malignant PE from non-malignant PE.
ABSTRACT
CONTEXT: Hyponatraemia is one of the common electrolytic disorders which are associated with lung cancer. Hyponatraemia may influence the ECOG performance status at presentation. Also, to the best of our knowledge, we found only limited Indian studies where the ECOG score was correlated with the serum sodium status in lung cancer patients on presentation. AIM: To assess the incidence of hyponatraemia among the patients of carcinoma of the lung before putting them into the specific treatment category for cancer and to check the effects on their ECOG performance status. SETTINGS AND DESIGN: A cross-sectional, observational study was conducted on 116 consecutive patients of lung cancer during the period from November 2011 to October 2012. MATERIAL AND METHODS: The patients with a histologically proven diagnosis of lung cancer were grouped initially according to their ECOG performance statuses. The serum sodium value of each patient was measured and the hyponatraemic patients were given treatment according to the protocol. The correlation of the ECOG performance status with the serum sodium of the lung cancer patients was measured. To check for any laboratory error in serum sodium, we selected (n = 58) age, sex and socioeconomic matched control patients. RESULTS: At presentation 44.8% of the lung cancer patients showed hyponatraemia [52/116]. The ECOG score was significantly poor in the advanced clinical stages (ECOG ≤2 Vs ECOG ≥ 3 in NSCLC cases, χ(2) =11.25, P=.0008). The ECOG performance status score at admission showed a negative correlation with the serum sodium status which was measured on admission among all the patients (Pearson correlation coefficient = - 0.186). The clinical stage of the lung cancer also showed a positive correlation with the ECOG score at admission in our study (Pearson correlation coefficient = 0.295). CONCLUSION: Hyponatraemia is not an uncommon condition and it should be suspected and screened in each patient, as it may influence the ECOG performance status score, which serves as an important factor in the prognosis of lung cancer.
ABSTRACT
Pleurodesis is considered as the best palliative therapy for the treatment of symptomatic malignant pleural effusion. Several chemical agents are used for this purpose with variable efficacy and safety. The present study is to compare the effectiveness and safety of talc and povidone iodine as chemical agents for pleurodesis in patients of malignant pleural effusion. Fifty-two patients with malignant pleural effusion admitted in the department of chest of Calcutta National Medical College, Kolkata were selected for the study. Pleurodesis with povidone iodine and talc in slurry was done in 28 and 24 patients respectively. Efficacy and safety of these agents were assessed during a follow-up period of six months. Among the 52 patients, 42 were males and 10 females. Age ranged from 40 to 64 years with mean age of 56.4 years. In 41 patients effusion was secondary to bronchogemic carcinoma, 8 had effusion secondary to breast carcinoma, 1 had effusion due to non-Hodgkin's lymphoma, while primary malignancy was unknown in 2 patients. Among the 24 patients treated with talc pleurodesis, 20 had bronchogenic carcinoma, 3 had breast carcinoma and 1 had unknown primary malignancy. Out of the 28 patients treated with povidone iodine pleurodesis, bronchogenic carcinoma was present in 21 patients, breast carcinoma in 5 patients, non-Hodgkin's lymphoma and unknown primary malignancy was present in 1 patient each. Pleurodesis with talc showed complete success in 19 patients, partial success in 3 patients and failure in 2 patients. Pleurodesis with povidone iodine showed complete response in 24 patients, partial response in 1 patient and failure in 3 patients. Chest pain occurred in 4 patients of talc pleurodesis and 5 patients of povidone iodine pleurodesis, 3 patients of each group had fever. There was no death in the peripleurodesis period. During the 6 months follow-up, 12 patients of talc pleurodesis and 18 patients of povidone iodine pleurodesis died. Talc is slurry and povidone iodine is equally effective and safe pleurodesing agent for symptomatic malignant pleural effusion. However povidone iodine can be preferred option because of easy availability and low cost.
