md-medicaldata

Authors

 

Tegeltija Dragana^1,2, Samardžija Golub^1,3, Lovrenski Aleksandra ^1,2, Eri Živka^1,2, Milan Popović<sup>4

1</sup>Katedra za patologiju, Medicinski fakultet, Univerzitet u Novom Sadu
²Centar za patologiju, Institut za plućne bolesti Vojvodine, Sremska Kamenica
³Institut za kardiovaskularne bolesti Vojvodine, Sremska Kamenica
⁴Katedra za histologiju i embriologiju, Medicinski Fakultet, Univerzitet u Novom Sadu

 

Rad je primljen 18.11.2017. / Prihvaćen 12.12.2017.

 

Correspondence to

asist. dr Dragana Tegeltija,
Katedra za patologiju, Medicinski fakultet, Univerzitet u Novom Sadu
Hajduk Veljkova 3, 21 000 Novi Sad
e-mail: dragana.tegeltija@mf.uns.ac.rs

 

 

Sažetak

 

Citološka analiza pleuralnog izliva je: jednostavna, brza, tačna, jeftina, minimalno invazina i najmanje bolna dijagnostička procedura za bolesnika. Ova analiza je bazirana na analizi ćelija koje su spontano odbačene u pleuralnu šupljnu. Cilj ove studije je da se oceni tačnost citološke analize pleuralnog izliva u dijagnostikovanju malignih oboljenja pleure. Retrospektivno smo analizirali 4 544 citoloških uzoraka pleuralnog izliva i 600 biopsijskih uzoraka pleure kod bolesnika lečenih na Institutu za plućne bolesti Vojvodine u Sremskoj Kamenici od 2006. - 2010. godine. Bolesnici su imali od 1 - 97 godina (prosečno 60±14,3). Muškaraca je bilo (63.6%), a žena (36.4%). U 83.5% slučajeva pleuralni izliv je bio udružen sa benignim procesima, a suspektno maligne i maligne ćelije su nađene u 16.5% slučajeva. U biopsijskim uzorcima pleure maligno oboljenje je bilo dijagnostikovano u 24% slučajeva od kojih je adenokarcinom bio najčešći histološki tip (42%). Kod 267 bolesnika smo analizirali pleuralni izliv i biopsiju pleure. Tačno negativan nalaz pleuralnog izliva bio je kod 67.87%, tačno pozitivan kod 10.47%, lažno negativan kod 17.98% i lažno pozitivan kod 0.75% pacijenata. Senzitivnost metode iznosila je (37.6%), specifičnost (98.9%), sveukupna tačnost (81.0%), pozitivna prediktivna vrednost (94%) i negativna prediktivna vrednost (79.6%). Senzitivnost i specifičnost citologije pleuralnog izliva je dobra te ova metoda treba da se koristi kao rutinska dijagnostička metoda. Niska senzitivnost i visoka specifičnost u našoj studiji je najverovatniije posledica primene strožijih kriterijuma u citološkoj analizi pleuralnog izliva. Konačnu dijagnozu treba donositi timski. Preduslov tačnijih citoloških dijagnoza pleuralnog izliva je timski rad, utreniranost i permanentna edukacija citopatologa i citotehničara.

 

 

 

Ključne reči:

pleuralni izliv, citologija, pleura.

 

 

Abstract

 

Cytological analysis of pleural effusion is simple, fast, precise, economic, minimally invasive and the least painful diagnostic procedure which is based on the examination of cells spontaneously released into the pleural cavity. The aim of this study is to evaluate the accuracy of cytological analysis of pleural effusion for diagnosis of malignant pleural diseases. We analyzed retrospectively 4 544 cytological samples of pleural effusion and 600 pleural biopsy samples of patients treated at the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica in period from 2006. to 2010. Patient`s age ranged from one to 97, with men to women ratio of 63.6% to 36.4%. In 83.4% of cases, pleural effusion was linked to the benign condition whereas malignant cells and those highly suspected for malignancy were found in 16.5% cases. In pleural biopsies malignant diseases were present in 24% cases from which the adenocarcinoma was the most frequent type (42%). In 267 patients we analyzed both pleural effusion and pleural biopsy. In patients with pleural effusions, true negative result was present in 67.87%, true positive in 10.47%, false negative in 17.98%, and false positive in 0.75% cases. Sensitivity was 37.6%, specificity was 98.9%, overall accuracy was 81%, positive predictive value was 94% and negative predictive value was 79.6%. Sensitivity and specificity of this method is satisfying and therefore this method should be used as routine diagnostic procedure. Low sensitivity and high specificity in our study is probably due to the application of very strict criteria in cytological analysis of pleural effusion. Team approach is suggested in bringing up the final diagnosis. Prerequisite for improved accuracy of cytologic diagnosis is team work, regular updates and permanent education of cytopathologists and cytotechnicians.

 

 

Key words:

pleural effusion, cytology, malignant effusions.

 

 

References

 

1. Froudarakis ME. Diagnostic Work-Up of pleural effusions. Respiration. 2008; 75:4-13.
2. Miserocchi G. Physiology pathophysiology of  pleural fluid turnover. Eur Respir J. 1997; 10:219-25.
3. Medfard A, Maskell N. Pleural effusion. Postgrad Med J. 2005; 81:702-10.
4. Antony VB at al. Management of malignant pleural effusions. Eur Respir J. 2001 Aug; 18(2):402-19.
5. Pongrac I. Atlas pulomološke citologije. Medicinska naklada, Zagreb, 2006.
6. Dewald G, Dines DE, Weiland LH, Gordon H. Usefulness of chromosome examination in the diagnosis of malignant       pleural effusions. N Engl J Med. 1976; 295:1494-1500.
7. Naylor B. Pleural, Peritoneal, and Pericardial Effusions. In Comprehensive   cytopathology; 3rd Edition, 510- 77, Elsevier Inc., 2008.
8. Đorđević M. Citološki atlas malignih tumora, Elit. Medica, Beograd, 1997/1998.
9. Thapar M, Mishra R, Sharma A, Goyal V. Critical analysis of cell block versus examination in effusions. J Cytol. 2009; 26(2):60-4.
10. Koss LG. Diagnostic cytology and its histopatologic bases. 4th. Philadelphia: JB Lippincot, 1992.
11. Light RW, Erozan YS, Ball WC. Cells in pleural fluid: their value in differential diagnosis. Arch Intern Med. 1973; 132:854-60.
12. Dias CC, Andrade JM, Ferriani RA, Villanova MG, Meirelles RS. Hemorrhagic ascites associated with endometriosis. A case report. J Reprod Med. 2000; 45:688-90.
13. Prakash UBS,  Reiman HM. Comparison of needle biopsy with cytological analysis for the evaluation of pleural effusion: analysis of 14 cases. Mayo Clin Proc. 1985; 60:158-64.
14. Maskell NA,  Butland RJA. BTS guidelines for the investigation of unilateral pleural effusions in adults. Thorax. 2003; 58 (l,2):ii8-ii17.
15. Irani DR, Underwood RD, Johnson EH, Greenberg SD. Malignant Pleural Effusions: A Clinical Cytopathological Study. Arch Intern Med. 1987; 147: 1133-36.
16. Capelozzi LV, Cheke da Rosa D, Felipe da Silva AS. The value of cytology and pleural biopsy in the differential diagnostic of nonspecific pleural effusions. J Pneumol. 2003; 29(4):1-21.
17. Pendharkar SR, Tremblay T. Guidance on how to identify the cause- A diagnostic approach to pleural effusion. J Respir Dis. 2007; 28(12):565-82.
18. Loddenkeper R. Medical thoracoscopy. In:LightRW, LeeYCG (eds). Textbook of pleural diseases. Arnold Press, London, 2003; 498-512.
19. Cibas S. Pleural, Pericardial and Peritoneal Fluids. In Cytology: Diagnostic Principles and Clinical Correlate; 3rd edition, 132-153, Elsevier Inc., 2009.
20. Samar A, El-Sheikh. The Diagnostic Value of Pleural Fluid Cytology in Benign and Malignant Pleural Effusions  Med. J Cairo Univ. 2012 June; 80 (2):95-103.
21. Vernon SE, Rosenthal DL. Sezary cells in ascit fluid. Acta Citol. 1979; 23:408-11.
22. Kalaajieh WK. Etology of exudative pleural effusion in adults in North Lebanon, Can Respir J. 2001 Mar- Apr; 8(2):93-7.
23. Liam CK, Lim KH, Wong CM. Causes of pleural exudates in a region with a high incidence of tuberculosis. Respirology. 2000 Mar;5(1):33-8.
24. Valdes L, Alvarez D, Valle JM, Pose A, Jose E. The etiology of pleural effusions in an area with high incidence of tuberculosis. Chest. 1996 Jan; 109(1):158-62.
25. Rashimi K, Shashikala P, Hiremath S, Basavaraj HG. Cells in pleural fluid and their vaue in differential diagnosis. J Cytol. 2008; 25(4):138-43.
26. Alvares E, Barrosos C, Sotto- Mayor R, Almeida AB,  Freitas CM. Pleural effusions of non- neoplastic etiloogy in a patient with a rare form of myeloma. Acta Med Port. 1995 Oct; 8:579-84.
27. Martin DE,  Arnau OA,  Martorell CM, Canto AA. Thoracocentesis for the assessment of lung cancer with pleural effusion. Arch Bronc. 2002 Oct; 38(10):479-84.
28. Perikleous P, Rathinam S, Waller DA. VATS and open chest surgery in diagnosis and treatment of benign pleural diseases. J Vis Surg. 2017 Jun; 3:84.
29. Kalomenidis I, Light RW. Eosinophilic pleural effusions. Curr Opin Pulm Med. 2003;9:254–60.
30. Krenke R, Nasilowski J, Korczynski P, Gorska K, Przybylowski T, Chazan R, et al. Incidence and aetiology of eosinophilic pleural effusion. Eur Respir J. 2009 May; 1111-17.
31. Shiramba TL, Bigirimana V, Imuragire J, Kalinganire N. Effusion cytology at king faisal hospital, Kigali: a review of 151 cases. RMJ. 2012 Sep; 69 (3):30-33.
32. Chesnutt MS, Prendrgast TJ, Lung I, Tierney LM, McPhee S, Papadakis J, eds Current Medical Diagnosis & Treatment. 43 ed. USA: McGraw- Hill;2004.
33. Gaur  DS, Chauhan N, Kusum A, Harsh M, Talekar M, Kishore S, et al. Pleural fluid analysis - role in diagnosing pleural malignancy. J Cytol. 2007; 24 (4):183-188.

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