Pearls and myths in pleural fluid analysis

Respirology

Volumn 16, Issue 1, 2011, Pages 44-52

  Porcel, José M ^a  

^a HOSPITAL ARNAU DE VILANOVA   (Spain)

Author keywords

Pleural effusion; Pleural fluid; Thoracentesis; Tuberculosis

Indexed keywords

ADENOSINE DEAMINASE; ANTIGEN; ANTINUCLEAR ANTIBODY; GAMMA INTERFERON; GLUCOSE; MESOTHELIN; NATRIURETIC PEPTIDE RECEPTOR A; PNEUMOCOCCUS ANTIGEN; TRIACYLGLYCEROL; TUMOR MARKER; UNCLASSIFIED DRUG;

ACCURACY; BACTERIUM CULTURE; CELL COUNT; CHEMICAL ANALYSIS; CHYLOTHORAX; CYTOKINE RELEASE; CYTOLOGY; DIAGNOSTIC ACCURACY; DIAGNOSTIC PROCEDURE; DIAGNOSTIC TEST; ENZYME ACTIVITY; EOSINOPHIL; ESOPHAGUS RUPTURE; EXUDATE; GRAM POSITIVE BACTERIUM; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; IMMUNOASSAY; IMMUNOCOMPETENT CELL; IMMUNOCYTOCHEMISTRY; LUNG EMBOLISM; LUNG VOLUME; LYMPHOCYTE; MESOTHELIOMA; NEUTROPHIL; NONHUMAN; PANCREAS DISEASE; PH MEASUREMENT; PLEURA EFFUSION; PLEURA FLUID; PREVALENCE; PRIORITY JOURNAL; REVIEW; SMEAR; STAINING; THORAX DRAINAGE; TUBERCULOSIS; TUBERCULOUS PLEURISY;

ADENOSINE DEAMINASE; EXUDATES AND TRANSUDATES; GLUCOSE; HIV INFECTIONS; HUMANS; LEUKOCYTE COUNT; MESOTHELIOMA; NATRIURETIC PEPTIDES; NEOPLASM METASTASIS; PARACENTESIS; PLEURAL EFFUSION; PLEURAL NEOPLASMS; PULMONARY EMBOLISM; TUBERCULOSIS, PULMONARY;

EID: 79952254901     PISSN: 13237799     EISSN: 14401843     Source Type: Journal    
DOI: 10.1111/j.1440-1843.2010.01794.x     Document Type: Review

References (50)

1. Collins TR, Sahn SA. Thoracentesis. Clinical value, complications, technical problems, and patient experience. Chest 1987; 91: 817-22.
2. Villena V, López-Encuentra A, García-Luján R et al. Clinical implications of appearance of pleural fluid at thoracentesis. Chest 2004; 125: 156-9. (Pubitemid 38114578)
3. Maldonado F, Hawkins FJ, Daniels CE et al. Pleural fluid characteristics of chylothorax. Mayo Clin. Proc. 2009; 84: 129-33.
4. Sallach SM, Sallach JA, Vasquez E et al. Volume of pleural fluid required for diagnosis of pleural malignancy. Chest 2002; 122: 1913-17. (Pubitemid 36051124)
5. Swiderek J, Morcos S, Donthireddy V et al. Prospective study to determine the volume of pleural fluid required to diagnose malignancy. Chest 2010; 137: 68-73.
6. Abouzgheib W, Bartter T, Dagher H et al. A prospective study of the volume of pleural fluid required for accurate diagnosis of malignant pleural effusion. Chest 2009; 135: 999-1001.
7. Bielsa S, Panadés MJ, Egido R et al. Accuracy of pleural fluid cytology in malignant pleural effusions. An. Med. Interna. 2008; 25: 173-7. (Pubitemid 351957054)
8. Dekker A, Bupp PA. Cytology of serous effusions. An investigation into the usefulness of cell blocks versus smears. Am. J. Clin. Pathol. 1978; 70: 855-60. (Pubitemid 9113460)
9. Jonasson JG, Ducatman BS, Wang HH. The cell block for body cavity fluids: do the results justify the cost? Mod. Pathol. 1990; 3: 667-70.
10. Metzgeroth G, Kuhn C, Schultheis B et al. Diagnostic accuracy of cytology and immunocytology in carcinomatous effusions. Cytopathology 2008; 19: 205-11. (Pubitemid 351965486)
11. Jalal R, Aftab K, Hasan SH et al. Diagnostic value of clot examination for malignant cells in serous effusions. Cytopathology 2009; 20: 231-4.
12. Barnes TW, Olson EJ, Morgenthaler TI et al. Low yield of microbiologic Studies on pleural fluid specimens. Chest 2005; 127: 916-21. (Pubitemid 40775524)
13. Ferrer A, Osset J, Alegre J et al. Prospective clinical and microbiological study of pleural effusions. Eur. J. Clin. Microbiol. Infect. Dis. 1999; 18: 237-41. (Pubitemid 29527967)
14. Porcel JM. Pleural fluid tests to identify complicated parapneumonic effusions. Curr. Opin. Pulm. Med. 2010 (in press).
15. Conner BD, Lee YC, Branca P et al. Variations in pleural fluid WBC count and differential counts with different sample containers and different methods. Chest 2003; 123: 1181-7. (Pubitemid 36444376)
16. Antonangelo L, Vargas FS, Almeida LP et al. Influence of storage time and temperature on pleural fluid adenosine deaminase determination. Respirology 2006; 11: 488-92. (Pubitemid 43824348)
17. Manosca F, Schinstine M, Fetsch PA et al. Diagnostic effects of prolonged storage on fresh effusion samples. Diagn. Cytopathol. 2007; 35: 6-11. (Pubitemid 46095107)
18. Rahman NM, Mishra EK, Davies HE et al. Clinically important factors influencing the diagnostic measurement of pleural fluid pH and glucose. Am. J. Respir. Crit. Care Med. 2008; 178: 483-90.
19. Chandler TM, McCoskey EH, Byrd RP et al. Comparison of the use and accuracy of methods for determining pleural fluid pH. South. Med. J. 1999; 92: 214-17.
20. Porcel JM, Peña JM, Vicente de Vera C et al. Reappraisal of the standard method (Light's criteria) for identifying pleural exudates. Med. Clin. (Barc) 2006; 126: 211-13.
21. Light RW. Clinical Practice. Pleural effusion. N. Engl. J. Med. 2002; 346: 1971-7. (Pubitemid 34651358)
22. Jenkinson F, Murphy MJ. Biochemical analysis of pleural and ascitic fluid: effect of sample timing on interpretation of results. Ann. Clin. Biochem. 2007; 44: 471-3. (Pubitemid 351724657)
23. Romero-Candeira S, Hernández L, Romero-Brufao S et al. Is it meaningful to use biochemical parameters to discriminate between transudative and exudative pleural effusions? Chest 2002; 122: 1524-9. (Pubitemid 35366059)
24. Porcel JM. Establishing a diagnosis of pleural effusion due to heart failure. Respirology 2009; 14: 471-3.
25. Porcel JM. The use of probrain natriuretic peptide in pleural fluid for the diagnosis of pleural effusions resulting from heart failure. Curr. Opin. Pulm. Med. 2005; 11: 329-33. (Pubitemid 41073158)
26. Porcel JM, Martínez-Alonso M, Cao G et al. Biomarkers of heart failure in pleural fluid. Chest 2009; 136: 671-7.
27. Porcel JM, Chorda J, Cao G et al. Comparing serum and pleural fluid pro-brain natriuretic peptide (NT-proBNP) levels with pleural-to-serum albumin gradient for the identification of cardiac effusions misclassified by Light's criteria. Respirology 2007; 12: 654-9. (Pubitemid 47414870)
28. Bynum LJ, Wilson JE 3rd. Characteristics of pleural effusions associated with pulmonary embolism. Arch. Intern. Med. 1976; 136: 159-62.
29. Romero Candeira S, Hernández Blasco L, Soler MJ et al. Biochemical and cytologic characteristics of pleural effusions secondary to pulmonary embolism. Chest 2002; 121: 465-9. (Pubitemid 34132984)
30. Porcel JM, Madroñero AB, Pardina M et al. Analysis of pleural effusions in acute pulmonary embolism: radiological and pleural fluid data from 230 patients. Respirology 2007; 12: 234-9. (Pubitemid 46239397)
31. Krenke R, Nasilowski J, Korczynski P et al. Incidence and aetiology of eosinophilic pleural effusion. Eur. Respir. J. 2009; 34: 1111-17.
32. Rubins JB, Rubins HB. Etiology and prognostic significance of eosinophilic pleural effusions. A prospective study. Chest 1996; 110: 1271-4. (Pubitemid 26380484)
33. Martínez García MA, Cases Viedma E, Perpiñá Tordera M et al. Repeated thoracentesis: an important risk factor for eosinophilic pleural effusion? Respiration 2003; 70: 82-6. (Pubitemid 36216652)
34. Porcel JM, Light RW. Parapneumonic pleural effusions and empyema in adults: current practice. Rev. Clin. Esp. 2009; 209: 485-94.
35. Porcel JM, Esquerda A, Bielsa S. Diagnostic performance of adenosine deaminase activity in pleural fluid: a single-center experience with over 2100 consecutive patients. Eur. J. Intern. Med. 2010 (in press).
36. Baba K, Hoosen AA, Langeland N et al. Adenosine deaminase activity is a sensitive marker for the diagnosis of tuberculous pleuritis in patients with very low CD4 counts. PLoS ONE 2008; 3: e2788.
37. Light RW. Update on tuberculous pleural effusion. Respirology 2010; 15: 451-8.
38. Porcel JM. Tuberculous pleural effusion. Lung 2009; 187: 263-70.
39. Porcel JM, Vives M, Esquerda A et al. Use of a panel of tumor markers (carcinoembryonic antigen, cancer antigen 125, carbohydrate antigen 15-3, and cytokeratin 19 fragments) in pleural fluid for the differential diagnosis of benign and malignant effusions. Chest 2004; 126: 1757-63. (Pubitemid 39643976)
40. Davies HE, Sadler RS, Bielsa S et al. Clinical impact and reliability of pleural fluid mesothelin in undiagnosed pleural effusions. Am. J. Respir. Crit. Care Med. 2009; 180: 437-44.
41. Rodriguez-Panadero F. Medical thoracoscopy. Respiration 2008; 76: 363-72.
42. Rakha EA, Patil S, Abdulla K et al. The sensitivity of cytologic evaluation of pleural fluid in the diagnosis of malignant mesothelioma. Diagn. Cytopathol. 2010 (in press).
43. Scherpereel A, Astoul P, Baas P et al. Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur. Respir. J. 2010; 35: 479-95.
44. Pomjanski N, Grote HJ, Doganay P et al. Immunocytochemical identification of carcinomas of unknown primary in serous effusions. Diagn. Cytopathol. 2005; 33: 309-15. (Pubitemid 41598050)
45. Luzze H, Elliott AM, Joloba ML et al. Evaluation of suspected tuberculous pleurisy: clinical and diagnostic findings in HIV-1- positive and HIV-negative adults in Uganda. Int. J. Tuberc. Lung Dis. 2001; 5: 746-53. (Pubitemid 32720559)
46. Porcel JM, Ruiz-González A, Falguera M et al. Contribution of a pleural antigen assay (Binax NOW) to the diagnosis of pneumococcal pneumonia. Chest 2007; 131: 1442-7. (Pubitemid 46762350)
47. Villena V, Pérez V, Pozo F et al. Amylase levels in pleural effusions: a consecutive unselected series of 841 patients. Chest 2002; 121: 470-4. (Pubitemid 34132985)
48. Haro-Estarriol M, Casamitjá-Sot MT, Alvarez-Castillo LA et al. Utility of amylase levels in malignant pleural effusions. Med. Clin. (Barc) 2007; 129: 372-4. (Pubitemid 47574103)
49. Porcel JM, Ordi-Ros J, Esquerda A et al. Antinuclear antibody testing in pleural fluid for the diagnosis of lupus pleuritis. Lupus 2007; 16: 25-7. (Pubitemid 46174312)
50. Dheda K, van Zyl-Smit RN, Sechi LA et al. Utility of quantitative T-cell responses versus unstimulated interferon-g for the diagnosis of pleural tuberculosis. Eur. Respir. J. 2009; 34: 1118-26.