Pleural effusions are a common presentation to general medical departments of district general hospitals in England. In such a setting, we know that the quality of diagnostic work-up as well as the treatment rates of lung cancer patients improve with trained respiratory physician leadership (Gupta P, Bhattacharya M, Mukherjee R. The role of a trained respiratory physician in lung cancer management. European Respiratory Journal 2008; 32: 52. 237s). Whether this improves the diagnosis of unilateral pleural effusions is not well understood.
Records were obtained for all pleural fluid cytology samples registered in our hospital's pathology laboratory over 2 semesters separated by 12 months (01 July to 31 December 2006 and 01 January to 30 June 2008). A trained respiratory physician was appointed as the lead for Lung Cancer and Mesothelioma in July 2007.
Whilst the catchment population of the hospital remained approximately unchanged (about 264000 people) between the two semesters, 65 pleural fluid cytology samples were sent from 47 patients diagnosing 16 malignancies in the second semester of 2006 compared to 100 samples from 77 patients diagnosing 26 malignancies in the first semester of 2008. This shows a 64% increase in the number of patients being tested for pleural fluid cytology and a 62% increase in malignancy diagnosis with trained respiratory physician leadership.
Our findings suggest that a trained respiratory physician leadership in the management of pleural effusions improves malignancy diagnosis rate.
Although the differences in the quality of care delivered by trained specialists versus general physicians have been well-documented in various disease areas (e.g. myocardial infarction, chronic obstructive pulmonary disease), such data are not readily available for management of pleural effusions in England. This is important because, other than respiratory physicians, pleural effusions present to general physicians, cardiologists and gastroenterologists. With the incidence of mesothelioma set to rise in the next few years, our findings highlight the need for dedicated respiratory physician leadership in the management of pleural diseases.
Ajikumar Kavidasan, No Financial Disclosure Information; No Product/Research Disclosure Information