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Communications to the Editor |

Cytology on Transudative Pleural Effusions Response FREE TO VIEW

Bayu Teklu, MD, FCCP
Author and Funding Information

Affiliations: J.M. Wainwright Memorial VA Medical Center, Walla Walla, WA,  San Donato Milanese, Italy

Correspondence to: Bayu Teklu, MD, FCCP, J.M. Wainwright Memorial VA Medical Center, 77 Wainwright Dr, Walla Walla, WA 99362



Chest. 1999;116(3):846-847. doi:10.1378/chest.116.3.846
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To the Editor:

Foresti et al in their Communication to the Editor in CHEST (December 1998)1 recommended that one perform a cytologic examination on every transudative pleural effusion, because 4 of their 106 patients (3.8%) had positive results of cytological examination with a transudative pleural fluid using Light’s criteria.2 These same four patients had, respectively, adenocarcinoma of the breast, lung adenocarcinoma, undetermined adenocarcinoma, and non-Hodgkin’s lymphoma.

I have the following comments regarding their letter:

  1. Light’s quoted criteria are not current. Light himself in his book3 added a third criterion for qualification as an exudate: a lactate dehydrogenase (LDH) level greater than two-thirds of the upper limit of the serum LDH level. According to this criterion, their second patient barely satisfies the criteria to be classified as a transudate.

  2. In their 1st paragraph, they quote Assi et al4 as not recommending performance of cytological examination for transudative pleural effusion. However, in their last paragraph, they seem to suggest the opposite.

  3. In the third paragraph, sentences two and four are identical. Was it a typographical error?

  4. Finally, it would be more appropriate to perform cytological examinations on patients with transudative pleural effusions who have proven malignancies at other sites, just as in the four patients of Foresti et al. I disagree with them that cytologies should be performed on all patients with transudative pleural effusions; it is not cost-effective, and it is a significant departure from the usual method that is taught and practiced.

The letter of Castro et al5 on the same topic deserves a comment as well. They do not, like others,1 tell us whether positive results from pleural cytological examinations followed or preceded the diagnosis of the different malignancies. They also fail to supply negative results of cytological examinations of pleural fluids, transudative or exudative. Without all this information, their recommendation to perform cytological examinations on all transudative pleural fluids is not warranted.

References

Foresti, V, Scolari, N, Villa, A (1998) Positivity of pleural fluid cytologic examination in transudative pleural effusions [letter].Chest114,1798-1799
 
Light, RW, Macgregor, MI, Luchisinger, PC, et al Pleural effusions: the diagnostic separation of transudates and exudates.Ann Intern Med1972;10,1907-1913
 
Light, RW Pleural diseases 3rd ed.1995,38-39 Williams & Wilkins. Baltimore, MD:
 
Assi, Z, Caruso, JL, Herndon, J, et al Cytologically proved malignant pleural effusions: distribution of transudates and exudates.Chest1998;113,1302-1304. [PubMed] [CrossRef]
 
Castro, DJ, Nuevo, DG, Perez-Rodriguez, E Cytologically proved malignant pleural effusions [letter]. Chest. 1998;;114 ,.:1798
 
To the Editor:

We thank Dr. Teklu for his interest in our Communication to the Editor (December 1998)1 on positive results of pleural fluid cytologic examination in transudative pleural effusions.

In regard to his comments, we would like to make the following remarks:

  1. According to Light’s criteria,2the pleural effusion of our second patient is a transudate. Moreover, in this patient the pleural fluid cholesterol level was 25 mg/dL. This fact3 also confirms that the pleural fluid can be classified as a transudate.

  2. The sentence in our last paragraph is unclear. We meant that even in a cost-reduction environment, the performance of a cytological examination is always important.

  3. In the third paragraph, sentence one is a typographical error.

  4. In three of our patients, malignancy was proven. In patient 2, malignancy was unknown at the time of thoracocentesis.

In conclusion, despite Dr. Teklu’s interesting comments, we believe that a cytological examination must be performed on every patient with a transudative pleural effusion, since knowing whether a pleural effusion is due to malignancy or to other causes is very important for prognosis and therapy.

References
Foresti, V, Scolari, N, Villa, A Positivity of pleural fluid cytologic examination in transudative pleural effusions [letter].Chest1998;114,1798-1799
 
Light, RW Pleural diseases 3rd ed.1995,38-39 Williams & Wilkins. Baltimore, MD:
 
Castro, DJ, Nuevo, DG, Perez-Rodriguez, E Cytologically proved malignant pleural effusions [letter]. Chest. 1998;;114 ,.:1798
 

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References

Foresti, V, Scolari, N, Villa, A (1998) Positivity of pleural fluid cytologic examination in transudative pleural effusions [letter].Chest114,1798-1799
 
Light, RW, Macgregor, MI, Luchisinger, PC, et al Pleural effusions: the diagnostic separation of transudates and exudates.Ann Intern Med1972;10,1907-1913
 
Light, RW Pleural diseases 3rd ed.1995,38-39 Williams & Wilkins. Baltimore, MD:
 
Assi, Z, Caruso, JL, Herndon, J, et al Cytologically proved malignant pleural effusions: distribution of transudates and exudates.Chest1998;113,1302-1304. [PubMed] [CrossRef]
 
Castro, DJ, Nuevo, DG, Perez-Rodriguez, E Cytologically proved malignant pleural effusions [letter]. Chest. 1998;;114 ,.:1798
 
Foresti, V, Scolari, N, Villa, A Positivity of pleural fluid cytologic examination in transudative pleural effusions [letter].Chest1998;114,1798-1799
 
Light, RW Pleural diseases 3rd ed.1995,38-39 Williams & Wilkins. Baltimore, MD:
 
Castro, DJ, Nuevo, DG, Perez-Rodriguez, E Cytologically proved malignant pleural effusions [letter]. Chest. 1998;;114 ,.:1798
 
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