Laboratory diagnostics of pleural effusion
Authors:
P. Jakubec; K. Palatka; T. Jakubcová; V. Kolek
Authors‘ workplace:
Klinika plicních nemocí a tuberkulózy Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Vítězslav Kolek, CSc.
Published in:
Vnitř Lék 2008; 54(3): 265-272
Category:
Review
Overview
Pleural effusion is a frequent reason for a pulmonologist´s investigation. Many pulmonary and extrapulmonary causes of pleural effusion exist. Heart failure, pneumonia and malignancies are the most frequent among them. Laboratory examination of pleural liquid is a corner stone of diagnostics. We use various biochemical, microbiological, cytologic and other methods. The first step is a differentiation between transudate and exudate. If the laboratory examinations are unsuccessful, we can use invasive procedures - pleural biopsy and thoracoscopy. Despite all modern diagnostic methods the causes of about 15 % pleural effusions remain unclear.
Key words:
pleural effusion - thoracocentesis - laboratory diagnostics - transudate - exudate
Sources
1. Light RW. Approach to the patient. In: RW Light (Ed). Pleural disease. 2nd ed. Philadelphia: Lea and Febiger 1990: 75-84.
2. Marel M. Pleurální syndrom - doporučené postupy pro praktické lékaře. Reg. č. o/036/058. Česká lékařská společnost J. E. Purkyně: Praha 2001.
3. Rubins J. Pleural effusion. eMedicine, 2007. Dostupné na »http://www.emedicine.com/med/topic1843.htm«
4. Marel M.et al. Incidence of pleural effusions in well-defined region: epidemiologic study in Central Bohemia. Chest 1993; 104: 1486-1489.
5. Marel M, Stastny B, Melisova L et al. Diagnosis of pleural effusions - experience with clinical studies 1986-1990. Chest 1995; 108: 1598-1603.
6. Rahman NM, Chapman SJ, Davies RJO. Pleural effusion: a structured approach to care. Br Med Bull 2005; 2: 31-47.
7. Hsu C. Cytologic detection of malignancy in pleural effusion: a review of 5 255 samples from 3811 patients. Diagn Cytopathol 1987; 3: 8-12.
8. Marel M, Fila L. Diferenciální diagnostika a léčba maligních pleurálních výpotků. Klin onkol 2001; 1: 16-19.
9. Heffner JE, Brown LK, Barbier CA. Diagnostic value of tests that discriminate between exudative and transudative pleural effussions. Primary Study Investigators. Chest 1997; 111: 970-980.
10. Light RW, MacGregor MI, Luchsinger PC et al. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972; 77: 507-513.
11. Allan JS, Donahue DM, Garrity JM. Rheumatoid Pleural Effusion in the Absence of rthritic Disease. Ann Thorac Surg 2005; 80: 1519-1521.
12. Fila L. Pleurální výpotky. Intern Med 2007; 9: 490-494.
13. Fila L, Musil J, Schützer J. Nemoci pleury. Praha: Triton 2006.
14. Jakubec P, Kolek V, Procházka V et al. Pankreatikopleurální píštěle. Vnitř Lék 2007; 53: 135-142.
15. Villena V, Pérez V, Pozo F et al. Amylase Levels in Pleural Effusions. Chest 2002; 121: 470-474.
16. Garcia-Pachon E, Padilla-Navas I. Urinothorax: Case Report and Review of the Literature with Emphasis on Biochemical Diagnosis. Respiration 2004; 71: 533-536.
17. Domej W, Tilz GP, Foldes-Papp Z et al. Cystatin C of pleural effusion as a novel diagnostic aid in pleural diseases of different aetiologies. Clin Science 2002; 102: 373-380.
18. Kolditz M, Halank M, Schiemanck CS et al. High diagnostic accuracy of NT-proBNP for cardiac origin of pleura effusions. Eur Respir J 2006; 28: 144-150.
19. Welker L, Müller M, Holz O et al. Cytological diagnosis of malignant mesothelioma-improvement by additional analysis of hyaluronic acid in pleural effusions. Virchows Arch 2007; 450: 455-461.
20. Nurminen M, Dejmek A, Mårtensson G et al. Clinical utility of liquid-chromatographic analysis of effusions for hyaluronate content. Clin Chem 1994; 40:777-780.
21. Atagi S, Ogawara M, Kawahara M et al. Utility of Hyaluronic Acid in Pleural Fluid for Differential Diagnosis of Pleural Effusions: Likelihood Ratios for Malignant Mesothelioma. Jpn J Clin Oncol 1997; 27: 293-297.
22. Zatloukal P, Fiala P, Votruba J et al. Pneumologie. Praha: Galén 2001.
23. Hrazdirová A, Skřičková J, Nebeský T. Tuberkulózní pleuritida. Stud Pneumol Phthiseol 2005; 65: 79-87.
24. Roth BJ. Searching for tuberculosis in the pleural space. Chest 1999; 116: 3-5.
25. Castro DJ, Nuevo GD, Pérez-Rodríguez E et al. Diagnostic value of adenosine deaminase in nontuberculous lymphotic pleural effusions. Eur Respir J 2003; 21: 220-224.
26. Kataria YP, Khurshid I. Adenosine Deaminase in the Diagnosis of Tuberculous Pleural Effusion. Chest 2001; 120: 334-336.
27. Laborín-Laniado R. Adenosine Deaminase in the Diagnosis of Tuberculous Pleural Effusion. Is It Really and Ideal Test? A Word of Caution. Chest 2005; 127: 417-418.
28. Alrokayan S. Adenosine Deaminase: An Aid to Diagnose Tuberculosis. J Med Sci 2003; 3: 30-45.
29. Inase N, Tominaga S, Zasuj M. Adenosine deaminase 2 in the diagnosis of tuberculous pleuritis. Kekkaku 2005; 80: 731-734.
30. Valdes L, San Jose E, Alvarez D et al. Diagnosis of tuberculous pleurisy using the biologic parameters adenosine deaminase, lysozyme and interferon γ. Chest 1993; 103: 458-465.
31. Sharma SK, Banga A. Diagnostic utility of pleural fluid IFN-γ in tuberculosis pleural effusion. J Interferon Cytokine Res 2004; 24: 213-217.
32. Miller KD. Measuring ADA in Pleural Fluids. International Pleural Newsletter 2004; 2: 6-7.
33. Light RW. Useful tests on the pleural fluid in the management of patients with pleurale effusions. Curr Opin Pulm Med 1999; 5: 245-249.
34. Barnes TW, Olson EJ, Morgenthaler TI et al. Low Yield of Microbiologic Studies on Pleural Fluid Specimen. Chest 2005; 127: 916-921.
35. Ferrer A, Osset J, Alegre J et al. Prospective Clinical and Microbiological Study of Pleural Effusions. Eur J Clin Microbiol Infect Dis 1999; 18: 237-241.
36. Maskell NA, Batt S, Hedley EL et al. The Bacteriology of Pleural Infection by Genetic and Standard Methods and Its Mortality Significance. Am J Respir Cri Care Med 2006; 174: 817-823.
37. Menezes-Martins LF, Menezes-Martins JJ, Michaelsen VS et al. Diagnosis of parapneumonic pleural effusion by polymerase chain reaction in children. J Pediatr Surg 2005; 40: 1106-1110.
38. Hamm H, Light RW. Parapneumonic effusion and empyema. Eur Respir J 1997; 10: 1150-1156.
39. Yew WW, Chan CY, Kwan SY et al. Diagnosis of tuberculous pleural effusion by the detection of tuberculasteric acid in pleural aspirates. Chest 1991; 100: 1261-1263.
40. Chen ML, Yu WC, Lam CW et al. Diagnostic value of pleural fluid adenosine deaminase activity in tuberculous pleurisy. Clin Chim Acta 2004; 341: 101-107.
41. Martinez-Garcia MA, Cases-Viedma E, Cordero-Rodriguez PJ et al. Diagnostic utility of eosinophils in the pleural fluid. Eur Respir J 2000; 15: 166-169.
42. Maskell NA, Butland RJ. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 2003; 58: ii8.
43. Fenton KN, Richardson D. Diagnosis and management of malignant pleural effusions. Am J Surg 1995; 170: 69-74.
44. Bueno CE, Clemente MG, Astro BC et al. Cytologic and bacteriologic analysis of fluid and pleural biopsy specimens with Cope´s needle: study of 414 patients. Arch Intern Med 1990; 150: 1190-1194.
45. Light RW. Pleural effusion. N Engl J Med 2002; 346: 1971-1977.
46. Garcia L. The value of multiple fluid specimen in the cytological diagnosis of malignancy. Mod Pathol 1994; 7: 665-668.
47. Shitrit D, Zingerman B, Shitrit AB et al. Diagnostic Value of CYFRA 21-1, CEA, CA 19-9, CA 15-3 and CA 125 Assays in Pleural Effusions: Analysis of 116 Cases and Review of the Literature. Oncologist 2005; 10: 501-507.
48. Porcel JM, Vives M, Esquerda A et al. Use of a Panel of Tumor Markers (Carcinoembryonic Antigen, Cancer Antigen 125, Carbohydrate Antigen 15-3 and Cytokeratin 19 Fragments) in Pleural Fluid for the Differential Diagnosis of Benign and Malignant Effusions. Chest 2004; 126: 1757-1763.
49. Ferrer F, Villarino MA, Encabo G et al. Diagnostic utility of CYFRA 21-1, carcinoembryonic antigen, CA 125, neurol specific enolase, and squamous cell antigen level determinations in the serum and pleural fluid of patients with pleural effusions. Cancer 1999; 86: 1488-1495.
50. Villena V, López Encuentra A, Echave-Sustaeta J et al. Diagnostic value of CA 549 in pleural fluid: comparison with CEA, CA 15.3 and CA 72.4. Lung Cancer 2003; 40: 289-294.
51. Paganuzzi M, Onetto M, Martini P et al. Diagnostic value of CYFRA 21-1 tumor marker and CEA in pleural effusion due to mesothelioma. Chest 2001; 119: 1138-1142.
52. Hung TL, Chen FF, Liu JM et al. Clinical Evaluation of HER-2/neu Protein in Malignant Pleural Effussion-Associated Lung Adenokarcinoma and as a Tumor Marker in Pleural Effusion Diagnosis. Clin Cancer Research 2003; 9: 2605-2612.
53. Whitaker D. The cytology of malignant mesothelioma. Cytopathology 2000; 11: 139-151.
54. Palatka K. Maligní mezoteliom. Postgraduální medicína 2006; 8: 694-699.
55. Abutaily AS, Adrie BJ, Roche WR. Immunohistochemistry in the distinction between malignant mesothelioma and pulmonary adenocarcinoma: a critical evaluation of new antibodies. J Clin Pathol 2002; 55: 662-668.
56. Jakubec P, Grygárková I, Kolek V et al. Pozitronová emisní tomografie v diagnostice a stagingu karcinomu plic. Stud Pneumol Phtiseol 2007; 67: 177-187.
57. Nance KV, Shermer RW, Askin FB. Diagnostic efficacy of pleural biopsy as compared with that of pleural fluid examination. Mod Pathol 1991; 4: 320-324.
58. Salyer WR, Eggleston JC, Erozan YS. Efficacy of pleural needle biopsy and pleural fluid cytopathology in the diagnosis of malignant neoplasm involving the pleura. Chest 1975; 67: 536-539.
59. Prakash UB, Reiman HM. Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases. Mayo Clin Proc 1985; 60: 158-164.
60. Poe RH, Israel RH, Utell MJ et al. Sensitivity, specificity and predictive values of closed pleural biopsy. Arch Intern Med 1984; 144: 325-328.
61. Ruffie P, Feld R, Minkin S et al. Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients. J Clin Oncol 1989; 7: 1157-1168.
62. Boutin C, Rey F. Thoracoscopy in malignant mesothelioma: a prospective study of 188 consecutive patients. I Diagnosis Cancer 1993; 72: 389-404.
63. Achatzy R, Beba W, Ritschler R et al. The diagnosis, therapy and prognosis of diffuse malignant mesothelioma. Eur J Cardiothorac Surg 1989; 3: 445-447.
64. Jakubec P, Kolek V, Václavík A et al. Necílená biopsie pleury v diagnostice maligního postižení pleury. Stud Pneumol Phtiseol 2006; 66: 119-123.
65. Chang DB, Yang PC, Luh KT et al. Ultrasound-guided pleural biopsy with Tru-cut needle. Chest 1991; 100: 1328-1333.
66. Scott EM, Marshall TJ, Flower CD et al. Diffuse pleural thickening: percutaneous CT-guided cutting needle biopsy. Radiology 1995; 194: 867-870.
67. Maskell NA, Gleeson FV, Davies RJO. Standard pleural biopsy vs CT-guided cutting needle biopsy for diagnosis of malignant disease in pleural effusions: a randomized controlled trial. Lancet 2003; 361: 1326-1331.
68. Adams RF, Gleeson FV. Percutaneous image-guided cutting needle biopsy of the pleura in the presence of a suspected malignant effusion. Radiology 2001; 219: 510-514.
69. Adams RF, Gray W, Davies RJO et al. Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma. Chest 2001; 120: 1798-1802.
70. Aksoy E, Atac G, Sevim T et al. Diagnostic yield of closed pleural brushing. Tuberk Toraks 2005; 53: 238-244.
71. Conde MB, Loivos AC, Rezende VM et al. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med 2003; 167: 723-725.
72. Kalomenidis J. New advances in the investigation of pleural diseases. Pneumon 2003; 3: 247-251.
73. Escudero BC, Garcia CM, Cuesta CB et al. Cytologic and bacteriologic analysis of fluid and pleural biopsy specimen with Cope´s needle. Study of 414 patients. Arch Intern Med 1990; 150: 1190-1194.
74. Hasneen NA, Zaki ME, Shalaby HM et al. Polymerase chain reaction of pleural biopsy is a rapid and sensitive method for the diagnosis of tuberculous pleural effusion. Chest 2003; 124: 2105-2111.
75. Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease. Ann Intern Med 1991; 114: 271-276.
76. Boutin C, Astoul P, Seitz B. The role of thoracoscopy in the evaluation and management of pleural effusions. Lung 1990; 168(Suppl): 1113-1121.
77. Diacon AH, Van de Wal BW, Wyser C et al. Diagnostic tools in tuberculous pleurisy: a direct comparative study. Eur Respir J 2003; 22: 589-591.
78. Harris RJ, Kavuru MS, Mehta AC et al. The impact of thoracoscopy on the management of pleural disease. Chest 1995; 107: 845-852.
79. Screaton NJ, Flower CD. Percutaneous needle biopsy of the pleura. Radiol Clin North Am 2000; 38: 293-301.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
![Issue 3](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/a5fbc78c260ffbb3935f50411a81e99a.jpeg)
2008 Issue 3
Most read in this issue
- Idiopathic retroperitoneal fibrosis - Ormond’s disease
- Von Willebrand disease
- SIADH as only paraneoplastic cause of the small cell lung cancer: case report
- Treatment of IgA nephropathy