PT  - JOURNAL ARTICLE
AU  - DT Arnold
AU  - D De Fonseka
AU  - S Perry
AU  - A Morley
AU  - JE Harvey
AU  - A Medford
AU  - M Brett
AU  - NA Maskell
TI  - Investigating Unilateral Pleural Effusions: The role of cytology
AID  - 10.1183/13993003.01254-2018
DP  - 2018 Jan 01
TA  - European Respiratory Journal
PG  - 1801254
4099  - http://erj.ersjournals.com/content/early/2018/09/12/13993003.01254-2018.short
4100  - http://erj.ersjournals.com/content/early/2018/09/12/13993003.01254-2018.full
AB  - The vast majority of undiagnosed unilateral pleural effusions have fluid sent for cytological analysis. Despite widespread use, there is uncertainty about its sensitivity to diagnose malignant pleural effusions (MPEs). Our aim was to ascertain the utility of cytology using a large prospective cohort.Consecutive patients presenting with an undiagnosed unilateral pleural effusion were recruited to this UK-based study. All had pleural fluid sent for cytological analysis. Cytological sensitivity was based on the final diagnosis at 12 months, confirmed by two consultants.Over 8-years, 921 patients were recruited, of which 515 had a MPE. Overall sensitivity of fluid cytology to diagnose malignancy was 46% (95%CI 42–58). There was variation in sensitivity depending on cancer primary, with mesothelioma (6%) and haematological malignancies (40%), being significantly lower than adenocarcinomas (79%). MPEs secondary to ovarian cancer had high pick-up rates (95%). In asbestos-exposed males with exudative effusions, the risk of MPE was 60%, but cytological sensitivity was 11%.This is the largest prospective study of pleural fluid cytology and informs discussions with patients about the likely requirement for investigations following thoracentesis. In patients presenting with a clinical suspicion of mesothelioma, cytological sensitivity is low, so more definitive investigations could be performed sooner.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Arnold has nothing to disclose.Conflict of interest: Dr. de Fonseka has nothing to disclose.Conflict of interest: Dr. Perry has nothing to disclose.Conflict of interest: Mrs Morley has nothing to disclose.Conflict of interest: Dr. Harvey has nothing to disclose.Conflict of interest: Dr. Medford has nothing to disclose.Conflict of interest: Dr. Brett has nothing to disclose.Conflict of interest: Prof. Maskell has nothing to disclose.