Disorders of the Pleura |

Clinical Value of Plasma B-Type Natriuretic Peptide (BNP) in Pleural Effusion: Correlation With Histology by Medical Thoracoscopy FREE TO VIEW

Pier Canessa, MD; Irene Morelli, MD; Lorenza Bancalari, MD; Massimiliano Sivori, MD; Daniele Bertoli, MD; Enrico Battolla, MD; Gianfranco Mazzotta, MD
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ASL 5 La Spezia, Sarzana, Italy

Chest. 2014;145(3_MeetingAbstracts):278A. doi:10.1378/chest.1833217
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SESSION TITLE: Pleural Disease/Pleural Effusion Posters

SESSION TYPE: Poster Presentations

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

PURPOSE: Pleural exudative effusion (PE) is a common finding in many pathological conditions including infections, malignancies, and cardiac failure. A high level of plasma BNP or serum pro BNP could determine a benign nature and exclude a diagnostic thoracoscopy. Aim of the study: to identify a relation between the level of plasma BNP and histological diagnosis by medical thoracoscopy, and to establish BNP diagnostic cut-off levels.

METHODS: From January 2008 to December 2011, we evaluated 186 consecutive patients ( 144 M; mean age 71.21, range 36-89) with PE who underwent medical thoracoscopy with a minimum of ten parietal pleural biopsies. Plasma BNP concentrations were measured at admission. The final diagnosis of pleural disease was assessed by histological criteria. Statistical analysis: binormal ROC curve analysis, ANOVA among groups and, if significant, Student's t-test.

RESULTS: We had: 66 malignant mesotheliomas with BNP 71,1±10,3 pg/ml; 30 pleural metastases with BNP 70,3±14,9 pg/ml; 90 benign effusions (BE) with BNP 252,8±50,7 pg/ml. There was a statistical difference between BE and all malignant pleural diseases: p=0,00002. A BNP cut-off < 200 pg/ml showed a 95% sensitivity for malignant disease and at cut-off > 410 pg/ml a 100% sensitivity for BE.

CONCLUSIONS: Plasma BNP concentration was significantly higher in patients with benign than malignant effusions. No malignant pleural effusion was diagnosed when serum BNP was more than 410 pg/ml.

CLINICAL IMPLICATIONS: In a pleural effusion of unknown origin, a serum BNP < 200 pg/ml induces to perform a medical thoracoscopy to obtain the diagnosis of pleural disease; a BNP > 410 could exclude a malignant pleural disease.

DISCLOSURE: The following authors have nothing to disclose: Pier Canessa, Irene Morelli, Lorenza Bancalari, Massimiliano Sivori, Daniele Bertoli, Enrico Battolla, Gianfranco Mazzotta

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