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Lung Cancer |

Controversies in Concordance Diagnosis Pre and Post Test in Malignant Pleural Effusions

Paola Arrieta Narvaez, MD; Esteban Perez Rodriguez, MD; Carolina Gotera, MD; Rosa Mirambeaux Villalona, MD; Carolina Jurkojc Mohremberger, MD; Patricia Lazo Meneses, MD; Salvador Diaz Lobato, MD; Sagrario Mayoralas Alises, MD; Eva Mañas Baena, MD; Jonathan Cámara Fernández, MD; Patricia Castro Acosta, MD; Maria Galarza Jimenez, MD; Deisy Barrios Barreto, MD
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Ramón y Cajal Teaching Hospital, Madrid, Spain


Chest. 2014;145(3_MeetingAbstracts):339A. doi:10.1378/chest.1822702
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Abstract

SESSION TITLE: Lung Cancer Posters I

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: In previous studies we have shown that the pretest and posttest diagnostic concordance in Pleural effusions (PE) is moderate (K: 0.55). In terms of sensitivity, the ascites hydrothorax have the greatest concordance (93%) and neoplasic showed very low. Knowing the reasons for this discrepancy in neoplasic pleural effusions may be useful in clinical practice. Objectives: 1. Analyze the overall concordance according to aetiology of the PE. 2. Evaluate the specific concordance in neoplasic pleural effusions and the reasons for the disagreement.

METHODS: From 1994 to October 2012, 5800 thoracentesis have been studied in the pleural unit, of them we analyzed 2558 consecutive thoracentesis included in the database. All cases were studied according to the protocol of the pleural unit and have Pre-test and post-test diagnostic. The pre-test diagnosis was based on clinical evaluation, radiological and laboratory test and was made by physician (Pleura expert pulmonologist and medical resident). The final diagnosis was closed according to study results of pleural effusion, biopsy, treatment response and outcome. The statistical analysis used was descriptive, retrospective and analyzed by the McNemar test.

RESULTS: Of the 2558 cases analyzed 1621 were men (63.4%) and 937 women (36.6%) and the mean age was 65.39 + / - 16.57 years. We analyzed 2558 cases, 2541 had diagnostic pretest and posttest (Table 1.), of which 530 were neoplasic (20.9%). The PE whose diagnosis was malignant pretest, the final diagnosis more frequent was malignant and idiopathic (Table 2). The most frecuente pretest diagnoses of neoplasic posttest diagnosis were: malignant (carcinomas, lymphomas, mesothelioma) and paramalignant. (Table 3) According to the McNemar test diagnostic concordance of neoplasic pretest / posttest showed a correlation of 44.8%. (Table 4)

CONCLUSIONS: 1. Diagnostic concordance pretest / posttest is high in ascites and cardiac PE, but not in the neoplasic PE. 2. When the diagnosis pre-test is malignant, the most frequent final diagnosis is malignant (55%) and idiopathic. If the pre-test diagnosis is no malignant, the suspected is correct in 92% of the cases. 3. When the diagnosis posttest is neoplasic the most frecuent suspected pretest diagnosis are paramalignant, parapneumonic and tuberculosis.

CLINICAL IMPLICATIONS: There is a low concordance in malignant pleural effusion, it is important to evaluate the specific concordance in neoplasic pleural effusions and the reasons for the disagreement.

DISCLOSURE: The following authors have nothing to disclose: Paola Arrieta Narvaez, Esteban Perez Rodriguez, Carolina Gotera, Rosa Mirambeaux Villalona, Carolina Jurkojc Mohremberger, Patricia Lazo Meneses, Salvador Diaz Lobato, Sagrario Mayoralas Alises, Eva Mañas Baena, Jonathan Cámara Fernández, Patricia Castro Acosta, Maria Galarza Jimenez, Deisy Barrios Barreto

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