Diagnostic Evaluation of Malignant Pleural Effusion

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تاریخ نمایه سازی: 5 آبان 1397

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Malignant pleural effusion (MPE) is one of the common causes of an exudative pleuraleffusion, and its incidence is increasing with increasing cancer prevalence and as more efficienttherapy that prolongs life of patients with cancer. MPE is a known complication of both thoracicand extrathoracic malignancies, and usually indicate disseminated or advanced disease. Most MPEsare secondary to metastasis from other sites , most commonly lung and breast, which together cause50 to 65% of all MPE.The diagnosis of MPE has been traditionally made on cytological evaluation of pleural fluidand/or histological examination of pleural tissue, and occasionally may be a challenging process.There has been great advancement in diagnosis of MPE in recent decades with development andprogression in interventional pulmonology techniques and advanced cytology i.e. image guidedbiopsies, medical and surgical thoracoscopy, tumor marker studies, immunohistochemical analysisetc., that have made possible an early diagnosis of MPE.Pleural fluid cytology is a simplest and definitive method to diagnose MPE. However, thediagnostic yeild of pleural fluid cytology ranges from 40 to 87%. The diagnostic yield of pleuralfluid cytology depends on several factors such as extend of disease, nature of specimens taken,experience of cytopathologist, use of fixative solutions, use of cell blocks in addition to smear andhistologic type of malignancy.Several tumor markers has been tested in patients of MPE. Routine use of tumor markers inthe diagnosis of MPE is presently not recommended. The application of immunophenotyping byflow cytometry to pleural effusion has proven to be extremely useful for subtyping of lymphocytespopulations and diagnosis lymphoma. Use of monoclonal antibody may help to differentiatemalignant from benign effusion, and in differentiating mesothelioma from adenocarcinoma.Biochemical/ biologic markers in malignant pleural effusion or serum cannot replace routine cytopathologic examination in the diagnosis of disease and predicting patient outcome without afirm diagnosis.These diagnostic perspectives stress the important role of cytopathologists and their closerelationship with clinicians, in the integrative diagnostic process.


Mahdia Gholamnejad

M.D, Assistant Professor of Pulmonology Urmia University of Medical Sciences, Urmia, Iran