DIAGNOSTIC UTILITY OF THORACENTESIS FOR NEUTROPENIC CHILDREN WITH CANCER

Thoracentesis is a procedure often performed on children with pleural effusions to assist in diagnosis and management. Its safety and utilit y for immunocompromised patients with neutropenia (absolute neutrophil count, <1,500 polymorphonuclear leukocytes and band forms per mu L) i s unclear. We reviewed our experience over a 10-year period to evaluat e the role of thoracentesis for neutropenic children with cancer who h ad pulmonary effusions of presumed infectious etiology. Twenty-two pat ients were identified, and 18 had absolute neutrophil counts of less t han or equal to 500/mu L. Empirical antibiotics had been administered to 95% of these patients and antifungal agents to 72%. Two patients' c ultures were positive for fungal organisms: Aspergillus terreus in one case and Candida albicans in the other, Both of these patients had be en receiving antifungal therapy. Therapy was altered for these two pat ients plus one additional patient in whose pleural fluid tumor cells w ere unexpectedly found. Eight of the remaining 19 patients underwent a nother diagnostic procedure, yielding five additional diagnoses. In co nclusion, thoracentesis is safe and should be considered as a diagnost ic test for febrile neutropenic patients with pulmonary effusions of p resumed infectious etiology, although more invasive tests may be warra nted.