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Disorders of the Pleura |

The Role of Cytology and Biopsy in Malignant and Tuberculosis Pleural Effusions in a Romanian Population

Oana Deleanu; Corina Oprea; Diana Pocora; Paraschiva Postolache; Florin Mihaltan, MD
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"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania


Chest. 2014;146(4_MeetingAbstracts):433A. doi:10.1378/chest.1992781
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Abstract

SESSION TITLE: Malignant Pleural Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Both tuberculosis and malignant pleural effusions are frequently encountered in Romania, having similar clinical and biochemical features. Identifying some features can help differentiate minimally invasive between tuberculosis and malignant pleurisy in a tuberculosis endemic country.

METHODS: We analysed retrospectively 36 patients completely investigated with malignant pleurisy and tuberculous pleurisy diagnosed during 2011 in Marius Nasta Institute of Pneumophtysiology, Bucharest, Romania, regarding demographics, clinical and laboratory findings. Pleural biopsies were taken blindly, using the Romanian patented Stoicescu biopsy needle. For statistical analysis we used SPSS 17.

RESULTS: 19 patients had tuberculos pleurisy, 17 patients had malingant pleurisy. Most patients were middle-aged men (48,9 ± 20,8 years), with a similar smoking history. The tuberculos pleurisy patients were younger (p=0.003), thiner (p=0.006), had more fever (p=0.03), higher seric lymphocytosis (p=0.01) and higher percentage of lymphocytes in the pleural effusion (p=0.001). Mycobacterium Tuberculosis was not identified on smears or cultures from the pleural effusion. There were no differences between groups regarding ADA in the pleural effusion. Surprisingly, increased seric tumoral markers were found in both groups, without any statistical difference regarding the type of marker or seric level. Tuberculosis pleurisy was more often confirmed by pleural biopsy (81.25%) and malignant pleurisy by tumoral cytology (81.5%); a negative tumoral cytology required biopsy which was diagnostic in 19% of malignancy cases.

CONCLUSIONS: Tumoral cytology is often enough for confirming a malignant pleurisy. Even though blinded, the pleural biopsy using the Stoicescu needle has high rates of positive diagnosis in both types of pleurisy. Studies are needed to state it’s efficacy compared to standard international needles (Cope, Abrams).

CLINICAL IMPLICATIONS: In a tuberculosis endemic country and with a majority of malignant cases identified in advanced stages, without access or training in thoracic ultrasound, pleural biopsy remains the procedure of choice as biochemical and bacteriological exams of pleural effusion have poor use in confirming etiology of a pleurisy.

DISCLOSURE: The following authors have nothing to disclose: Oana Deleanu, Corina Oprea, Diana Pocora, Paraschiva Postolache, Florin Mihaltan

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