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(Chest. 1998;113:1302-1304.)
© 1998 American College of Chest Physicians

Cytologically Proved Malignant Pleural Effusions

Distribution of Transudates and Exudates

Zakaria Assi 1; James L. Caruso MD2; James Herndon PhD3; and Edward F. Patz Jr. MD4

1 From the Department of Internal Medicine, Duke University Medical Center, Durham, NC.
2 From the Department of Pathology, Duke University Medical Center, Durham, NC.
3 From the Division of Biometry, Duke University Medical Center, Durham, NC.
4 From the Department of Radiology, Duke University Medical Center, Durham, NC.

Purpose: This study attempts to determine the distribution of transudates vs exudates in pathologically proved malignant pleural effusions and the necessity for cytologic studies in patients with a transudative effusion.

Materials and Methods: A retrospective review of all cytologically positive malignant pleural effusions was performed at Duke University Medical Center over an 18-month period. All effusions were characterized as a transudate or an exudate based on standard criteria, including lactate dehydrogenase and protein values.

Results: Ninety-eight patients with a mean age of 62 years were identified as having a cytologically positive malignant pleural effusion and blood chemistry values available to distinguish an exudate from transudate. Ninety-seven patients (99%, 95% confidence interval; 0.94 to 0.99) had criteria for an exudative effusion. One patient (1%) with diffuse metastatic lung cancer had a borderline transudate and was in congestive heart failure at the time of thoracentesis.

Conclusions: Cytologically positive pleural effusions for malignancy are almost always exudates. Cytologic evaluation for malignant cells of a transudative pleural effusion is not recommended.

Submitted on September 9, 1997
Accepted on October 23, 1997




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