Mount Sinai Hospital
Correspondence to: Michael S. Miletin, MD, Room 2-042, St. Michael’s Hospital, 30 Bond St, Toronto, Ontario M5W 1W8 Canada; e-mail: email@example.com
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
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.2–3 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
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