DIAGNOSIS OF PLEURAL EFFUSIONS - EXPERIENCE WITH CLINICAL-STUDIES, 1986 TO 1990

Objectives: To identify in patients with pleural effusion which proced ures are most useful in separating malignant from nonmalignant pleural effusions and to identify which procedures most commonly lead to a de finitive diagnosis. Design: Prospective consecutive case series. Setti ng: Pulmonary referral hospital in Prague, Czech Republic. Patients: O ne hundred seventy-one adults between ages 18 and 70 years with a pleu ral effusion and a Karnofsky score of 70 or above. Interventions: All patients underwent history, physical, pleural fluid cytologic study, l aboratory evaluation of serum and pleural fluid, pleural biopsy, bronc hoscopy, and lung scan and/or pulmonary arteriogram. Results: In this series in which 45% of the patients had malignant effusions, 19% had p aramalignant effusions, and 36% had benign diseases, the pleural fluid cytologic study was the best for establishing a diagnosis. The pleura l fluid carcinoembryonic antigen (CEA) levels above 10 had a high spec ificity (90%) for malignancy but had low sensitivity (37%). The pleura l fluid CEA level was increased only in 19% of patients with paramalig nant effusions. Although there were statistically significant differen ces in the mean results on several biochemical tests of pleural fluid, none were very accurate in separating malignant from benign disease. Conclusion: From this study, we conclude that patients with an undiagn osed pleural effusion should be evaluated in an individualized stepwis e manner. If malignancy is strongly considered, the initial three step s should be relatively noninvasive and include clinical evaluation and cytologic study.