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Original Research: MALIGNANT DISEASE |

A Prospective Study of the Volume of Pleural Fluid Required for Accurate Diagnosis of Malignant Pleural Effusion

Wissam Abouzgheib, MD, FCCP; Thaddeus Bartter, MD, FCCP; Hikmat Dagher, MD; Melvin Pratter, MD, FCCP; William Klump, MD
Author and Funding Information

*From the Departments of Pulmonary and Critical Care Medicine (Drs. Abouzgheib, Bartter, Dagher, and Pratter) and Pathology (Dr. Klump), Cooper University Hospital, Camden, NJ.

Correspondence to: Wissam Abouzgheib, MD, Lung Center at Sparks Health System, PO Box 17006, Fort Smith, AR 72917-7006; e-mail: wabouzgh@sparks.org


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(4):999-1001. doi:10.1378/chest.08-2002
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Background:  This is a prospective study to define the volume of pleural fluid adequate for maximal yield of cytologic analysis of pleural fluid.

Methods:  Patients undergoing diagnostic thoracentesis with malignancy in the differential diagnosis were enrolled in the study. The first 50 mL of pleural fluid were put in a specimen cup, and subsequent fluid was collected in a drainage bag. Both samples were sent for cytologic evaluation. The cytologist was blinded as to which specimen was being evaluated.

Results:  Forty-four patients (21 men, 23 women; mean [± SD] age, 46 ± 11.1 years) were enrolled in the study. The average volume of the “large-volume” specimen was 890 ± 375 mL (range, 250 to 1,800). Although malignant pleural involvement had never been documented for any patients, 31 patients had received a diagnosis of malignancy prior to undergoing thoracentesis. Cytologic tests were positive for malignancy in 23 of the 44 patients (55%). In the group of patients with an established history of cancer, pleural fluid was positive for malignant cells in 19 of 33 samples (58%). In all 23 patients with malignant pleural effusion, both the 50-mL specimen and the large-volume specimen were cytologically identical. In all 21 patients with negative pleural cytology findings, there was again 100% concordance between the 50-mL samples and the larger samples. The minimum adequate pleural fluid volume for cytologic diagnosis has been a matter of debate. The strongest data to date came from a retrospective study in 2002.

Conclusions:  Our prospective study now unequivocally supports the concept that the submission of > 50 mL of pleural fluid for cytologic analysis does not increase diagnostic yield.


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