Cytology and chest computed tomography findings of pleural effusion in patients with lung cancer

Malignant pleural effusionas presenting manifestation in lung cancer is of poor prognosis. Therefore, diagnostic approach in this patient population is important. Pleural cytology (PC) and chest computed tomography findings (CCT) might be helpful as first line approach in the diagnosis of pleural metastasis. The aim of this study was to evaluate whether there is a correlation between PC and CCT pleural findings. Methods: Selection criteria from our electronic files were patients with lung cancer and pleural effusionat initial presentation. Data of PC, pleural biopsy (PB) and CCT have been recorded and analyzed. Results: 47 consecutive patients (34 males, 72%) were selected. Their mean age was 68.5±11 years. Final histological diagnosis was adenocarcinoma in 28 patients (59%), squamous in 7 (15%), small-cell in 7 (15%) and large cell in 5 (11%). No findings were found in 29 patients (61%), nodules or masses were observed in 6 patients (13%) while pleural thickeningin 12 (26%) at CCT. Nodules and thickening were more likely to be associated (chi square=20, p<0.0001). PC was positive in 30 patients (64%), while PB in 8 out of 9 performed (89%). In 9 patients pleural effusionremained undiagnosed after initial evaluation (19%). No relation was observed between CCT findings and PC (chi square=0.2, p<0.6) or PB (chi square=1.2, p<0.27). Conclusion: In lung cancer patients with pleural effusionat presentation, CCT showed in most of the cases no pleural lesion.An association of nodules/masses to pleural thickeningwas observed. PC and PB had a high diagnostic yield. Thoracoscopicbiopsies should be proposed in this patient population with negative initial pleural approach.