Pleural fluid tumour markers in malignant pleural effusion with inconclusive cytologic results.

BACKGROUND: The presence of tumour cells in pleural fluid or tissue defines an effusion as malignant. Cytology analysis of the pleural fluid has about 60% diagnostic sensitivity. Several tests have been proposed to improve diagnosis-among them, the concentrations of tumour markers in pleural fluid. We evaluated whether the concentrations of tumour markers in pleural fluid could improve the diagnosis of malignant pleural effusion (mpe) when cytology is doubtful. METHODS: Lymphocytic pleural fluids secondary to tuberculosis or malignancy from 156 outpatients were submitted for cytology and tumour marker quantification [carcinoembryonic antigen (cea), cancer antigen 15-3 (ca15-3), carbohydrate antigen 19-9 (ca19-9), cancer antigen 72-4 (ca72-4), cancer antigen 125 (ca125), and cyfra 21-1). Oneway analysis of variance, the Student t-test or Mann-Whitney test, and receiver operating characteristic curves were used in the statistical analysis. RESULTS: Concentrations of the tumour markers cea, ca15-3, ca125, and cyfra 21-1 were higher in mpes than they were in the benign effusions (p < 0.001), regardless of cytology results. The markers ca19-9 and ca72-4 did not discriminate malignant from benign effusions. When comparing the concentrations of tumour markers in mpes having positive, suspicious, or negative cytology with concentrations in benign effusions, we observed higher levels of cea, ca15-3, cyfra 21-1, and ca125 in malignant effusions with positive cytology (p = 0.003, p = 0.001, p = 0.002, and p = 0.001 respectively). In pleural fluid, only ca125 was higher in mpes with suspicious or negative cytology (p = 0.001) than in benign effusions. CONCLUSIONS: Given high specificity and a sensitivity of about 60%, the concentrations of tumour markers in pleural effusions could be evaluated in cases of inconclusive cytology in patients with a high pre-test chance of malignancy or a history of cancer.

Comparison of the international normalized ratio levels obtained by portable coagulometer and laboratory in a clinic specializing in oral anticoagulation.

INTRODUCTION: Therapy with Vitamin K antagonists (VKA) is effective in reducing thromboembolic events in various diseases. There are limitations however, which limit clinical handling and maintaining INR within therapeutic range. Studies have shown that portable coagulometers, when compared to laboratory tests, are more practical and provide better patient adherence and involvement toward treatment which results in better INR control. This study aimed to evaluate laboratory obtained INR results compared to two different portable coagulometers. METHODS: A prospective study which monitored 1009 patients using VKA in the Anticoagulation Clinic at the Institute Dante Pazzanese of Cardiology in São Paulo between July and September 2012. Patient INR values were obtained by the laboratory through venipuncture and then compared to INR values obtained by capillary puncture from two different portable coagulometers. RESULTS: Overall, 1009 patients were included in the study; among these, 520 (51.5%) are male with average age of 59.6 years (13-91). The more common indications were atrial fibrillation (49.9%) and mechanical prosthesis (33.7%). The correlation coefficient was of 0.95 with and 0.88 with INRatio PT Monitor(®) compared to laboratory. In patients with INR < 2 (lower than therapeutic range), the coefficient was 0.92 and 0.81 for CoaguChek XS plus(®) and INRatio PT Monitor(®) respectively. In patients within therapeutic range (INR 2-3), the coefficient was 0.86 with CoaguChek XS Plus(®) and 0.76 with INRatio PT Monitor(®) . For INR above therapeutic range (INR > 3.0) the correlation was 0.80 with CoaguChek XS Plus(®) and 0.54 with INRatio PT Monitor(®) . As for concordance between methods, the intraclass correlation coefficients (ICC) were slightly smaller than those previously stated (ICC = 0.899 with CoaguChek XS Plus(®) and ICC = 0.716 with INRatio PT Monitor(®) ). CONCLUSION: The use of portable coagulometers was comparable to laboratory tests and better correlation coefficients were observed with CoaguChek XS Plus(®) and in patients with INR lower or within therapeutic range. Portable coagulometers proved to be a useful and reliable tool for INR control in patients using VKA.

Comparison of the international normalized ratio levels obtainedby portable coagulometer and laboratory in a clinic specializing inoral anticoagulation

Therapy with Vitamin K antagonists (VKA) is effectivein reducing thromboembolic events in various diseases. There arelimitations however, which limit clinical handling and maintainingINR within therapeutic range. Studies have shown that portable coagulometers,when compared to laboratory tests, are more practicaland provide better patient adherence and involvement towardtreatment which results in better INR control. This study aimed toevaluate laboratory obtained INR results compared to two differentportable coagulometers.Methods: A prospective study which monitored 1009 patients usingVKA in the Anticoagulation Clinic at the Institute Dante Pazzaneseof Cardiology in S~ao Paulo between July and September 2012.Patient INR values were obtained by the laboratory through venipunctureand then compared to INR values obtained by capillarypuncture from two different portable coagulometers.Results: Overall, 1009 patients were included in the study; amongthese, 520 (51.5%) are male with average age of 59.6 years (13–91). The more common indications were atrial fibrillation (49.9%)and mechanical prosthesis (33.7%). The correlation coefficient wasof 0.95 with and 0.88 with INRatio PT Monitor compared to laboratory.In patients with INR 3.0) the correlation was 0.80 with CoaguChek XSPlus and 0.54 with INRatio PT Monitor ...

Effect of temperature and storage time on cellular analysis of fresh pleural fluid samples.

OBJECTIVE: Despite the methodological variability in preparation techniques for pleural fluid cytology, it is fundamental that the cells should be preserved, permitting adequate morphological classification. We evaluated numerical and morphological changes in pleural fluid specimens processed after storage at room temperature or under refrigeration. METHODS: Aliquots of pleural fluid from 30 patients, collected in ethylenediaminetetraacetic acid-coated tubes and maintained at room temperature (21 °C) or refrigeration (4 °C) were evaluated after 2 and 6 hours and 1, 2, 3, 4, 7 and 14 days. Evaluation of cytomorphology and global and percentage counts of leucocytes, macrophages and mesothelial cells were included. RESULTS: The samples had quantitative cellular variations from day 3 or 4 onwards, depending on the storage conditions. Morphological alterations occurred earlier in samples maintained at room temperature (day 2) than in those under refrigeration (day 4). CONCLUSIONS: This study confirms that storage time and temperature are potential pre-analytical causes of error in pleural fluid cytology.