0
Communications to the Editor |

Transudative Pleural Effusions : False Reassurance Against Malignancy FREE TO VIEW

Yuri Moltyaner, MD; Michael S. Miletin, MD; Ronald F. Grossman, MD
Author and Funding Information

Mount Sinai Hospital Toronto, Ontario Canada

Correspondence to: Michael S. Miletin, MD, Room 2-042, St. Michael’s Hospital, 30 Bond St, Toronto, Ontario M5W 1W8 Canada; e-mail: mike.miletin@utoronto.ca



Chest. 2000;118(3):885. doi:10.1378/chest.118.3.885
Text Size: A A A
Published online

To the Editor:

We wish to draw the attention of readers to a retrospective study, performed at our institution, of malignant pleural effusions in medical and surgical inpatients. The presence of a pleural effusion and of malignant cells on cytopathologic examination of a pleural fluid sample obtained from the subject by thoracentesis was required for study inclusion. Each case also had to have sufficient data to allow application of the classic criteria of Light et al1 for determining whether the pleural fluid sample sent for cytopathologic examination was transudative or exudative. The presence of coexisting congestive heart failure, liver cirrhosis, or nephrotic syndrome was determined by reviewing the clinical impressions of the treating physicians as well as all relevant laboratory and imaging studies. We identified 88 patients in a 7-year period from 1991 through 1997.

We found that 8% of the malignant pleural effusions in these subjects were transudates. The average age of these patients was 70.4 years, and 47 of them were women. The primary malignancies experienced by the subjects included the following: breast (two), prostate, colon, lymphoma, small cell lung cancer, and an adenocarcinoma of unknown primary. All patients underwent two-dimensional echocardiography at the time of the initial investigation of their pleural effusions. Four patients were found to have ejection fractions > 60%. Although three patients were found to have an ejection fraction < 40%, only one of these patients had clinical and/or radiographic evidence of congestive heart failure at the time of thoracentesis. No patient had evidence of liver cirrhosis or nephrotic syndrome.

Investigators have previously demonstrated that up to 20% of pleural effusions occurring in subgroups of patients with active malignant disease are transudates.23 However, it is unknown what proportion of these patients had positive pleural fluid cytology. In a study that used Light’s criteria to classify malignant pleural effusions, Assi and coworkers4 found that only 1% were transudates. Contrary to the conclusions of these authors, we feel that this low rate may provide clinicians false reassurance when evaluating patients with transudative pleural effusions. Our findings lead us to suggest that clinicians should include cytopathologic examination of the pleural fluids in the diagnostic workup of all new pleural effusions.

Light, RW, McGregor, MI, Luchsinger, PC, et al (1972) Pleural effusion: the diagnostic separation of transudates and exudates.Ann Intern Med77,507-513. [PubMed]
 
Vives, M, Porcel, JM, Vincente de Vera, M, et al A study of Light’s criteria and possible modifications for distinguishing exudative from transudative pleural effusion.Chest1996;109,1503-1507. [CrossRef] [PubMed]
 
Romero, S, Candela, A, Martin, C, et al Evaluation of different criteria for the separation of pleural transudates and exudates.Chest1993;104,339-404
 
Assi, Z, Caruso, JL, Herndon, J, et al Cytologically proved malignant pleural effusions: distribution of transudates and exudates.Chest1998;113,1302-1304. [CrossRef] [PubMed]
 

Figures

Tables

References

Light, RW, McGregor, MI, Luchsinger, PC, et al (1972) Pleural effusion: the diagnostic separation of transudates and exudates.Ann Intern Med77,507-513. [PubMed]
 
Vives, M, Porcel, JM, Vincente de Vera, M, et al A study of Light’s criteria and possible modifications for distinguishing exudative from transudative pleural effusion.Chest1996;109,1503-1507. [CrossRef] [PubMed]
 
Romero, S, Candela, A, Martin, C, et al Evaluation of different criteria for the separation of pleural transudates and exudates.Chest1993;104,339-404
 
Assi, Z, Caruso, JL, Herndon, J, et al Cytologically proved malignant pleural effusions: distribution of transudates and exudates.Chest1998;113,1302-1304. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543