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1.
Anticancer Res ; 40(10): 5877-5881, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988918

RESUMO

BACKGROUND/AIM: Pleural effusion (PE) has a heterogeneous aetiology, and differential diagnosis between benign and malignant disease may require invasive procedures in up to 60% of cases. The sensitivity of pleural cytology is limited, and several strategies have been tested to reduce the need of invasive diagnostic approaches. The aim of this study was to evaluate the usefulness of pleural fluid cytology, compared to, and combined with, carcinoembryonic antigen (CEA), C reactive protein (CRP), and lactate dehydrogenase (LDH) assay of pleural fluid (PF) in patients with a history of cancer, exudative non-purulent PE, and suspicion of malignant PE on imaging studies. PATIENTS AND METHODS: The medical records of 40 patients with pulmonary metastases and malignant PE, and 57 controls with benign exudative PE were reviewed. All the patients underwent pleural cytology and CEA, CRP, and LDH assay before VATS-guided biopsy. RESULTS: The sensitivity and specificity were 55.0% and 98.2% (cytology), 35.0% and 98.2% (CEA), 92.5% and 71.9% (CRP), 70.0% and 54.4% (LDH). The multivariate analysis excluded LDH, and the final AUC (cytology+CEA+CRP) was 0.894. CONCLUSION: In all patients with a history of cancer and PE of uncertain origin, the combination of PF cytology plus pleural CEA and CRP assay together should be suggested to recognize malignant plural effusion (MPE), minimising the use of unnecessary invasive investigations.


Assuntos
Diagnóstico Diferencial , Neoplasias/diagnóstico , Pleura/metabolismo , Derrame Pleural Maligno/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Proteína C-Reativa/metabolismo , Antígeno Carcinoembrionário/metabolismo , Citodiagnóstico/métodos , Feminino , Humanos , L-Lactato Desidrogenase/metabolismo , Masculino , Pessoa de Meia-Idade , Neoplasias/metabolismo , Neoplasias/patologia , Pleura/patologia , Derrame Pleural Maligno/metabolismo , Derrame Pleural Maligno/patologia
2.
BMC Med Inform Decis Mak ; 20(1): 179, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32758243

RESUMO

BACKGROUND: Malignant pleural effusion (MPE) is a common, serious problem predominantly seen in metastatic lung and breast cancer and malignant pleural mesothelioma. Recurrence of malignant pleural effusion is common, and symptoms significantly impair people's daily lives. Numerous treatment options exist, yet choosing the most suitable depends on many factors and making decisions can be challenging in pressured, time-sensitive clinical environments. Clinicians identified a need to develop a decision support tool. This paper reports the process of co-producing an initial prototype tool. METHODS: Creative co-design methods were used. Three pleural teams from three disparate clinical sites in the UK were involved. To overcome the geographical distance between sites and the ill-health of service users, novel distributed methods of creative co-design were used. Local workshops were designed and structured, including video clips of activities. These were run on each site with clinicians, patients and carers. A joint national workshop was then conducted with representatives from all stakeholder groups to consider the findings and outputs from local meetings. The design team worked with participants to develop outputs, including patient timelines and personas. These were used as the basis to develop and test prototype ideas. RESULTS: Key messages from the workshops informed prototype development. These messages were as follows. Understanding and managing the pleural effusion was the priority for patients, not their overall cancer journey. Preferred methods for receiving information were varied but visual and graphic approaches were favoured. The main influences on people's decisions about their MPE treatment were personal aspects of their lives, for example, how active they are, what support they have at home. The findings informed the development of a first prototype/service visualisation (a video representing a web-based support tool) to help people identify personal priorities and to guide shared treatment decisions. CONCLUSION: The creative design methods and distributed model used in this project overcame many of the barriers to traditional co-production methods such as power, language and time. They allowed specialist pleural teams and service users to work together to create a patient-facing decision support tool owned by those who will use it and ready for implementation and evaluation.


Assuntos
Neoplasias da Mama , Sistemas de Apoio a Decisões Clínicas , Neoplasias Pulmonares , Mesotelioma , Derrame Pleural Maligno/terapia , Neoplasias Pleurais/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Tomada de Decisões , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Mesotelioma/patologia , Mesotelioma/terapia , Derrame Pleural Maligno/diagnóstico , Neoplasias Pleurais/secundário
3.
Asian Cardiovasc Thorac Ann ; 28(9): 560-565, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32741198

RESUMO

BACKGROUND: Differentiation between benign and malignant exudative pleural effusion remains a clinical challenge. Recently, several markers have been reported to increase the diagnostic accuracy of malignant pleural effusion, with controversial results. METHODS: Patients with exudative pleural effusion were divided into 2 groups: a malignant pleural effusion group (39 patients) diagnosed by malignant cells in pleural fluid cytology or by malignant infiltration of the pleura on pleural biopsy, and a benign pleural effusion group (51 patients) with neither malignant cells in pleural fluid cytology nor malignant infiltration of the pleura on pleural biopsy. Matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 were determined in both serum and pleural fluid samples, using commercially available enzyme-linked immunosorbent assay kits. RESULTS: The etiology of malignant pleural effusion in the malignant group was breast cancer in 43.6% and bronchogenic carcinoma in 25.6%. There was a statistically significant difference between the 2 groups regarding sex, with more males in the benign group. There was no significant difference between groups regarding age. The median levels of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 were higher in the malignant group than in the benign group, and the differences were highly significant in both pleural fluid (p < 0.001) and serum (p < 0.001). CONCLUSION: Matrix metaloproteinase-9 and tissue inhibitor of metalloproteinase-1 in serum and pleural fluid samples might be valuable markers for differentiating benign from malignant pleural effusions.


Assuntos
L-Lactato Desidrogenase/sangue , Metaloproteinase 9 da Matriz/sangue , Derrame Pleural Maligno/diagnóstico , Derrame Pleural/diagnóstico , Inibidor Tecidual de Metaloproteinase-1/sangue , Adulto , Biomarcadores/sangue , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/sangue , Derrame Pleural Maligno/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Toracentese
4.
Am J Clin Pathol ; 154(3): 394-402, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32525969

RESUMO

OBJECTIVES: A definitive diagnosis of malignancy may not be possible in pleural effusions. We report our experience with the diagnosis of suspicious for malignancy (SFM) in pleural effusion. METHODS: A search for pleural effusions diagnosed as SFM (2008-2018) was performed. Patient records and pathology reports were reviewed. Specimens were subdivided into groups depending on volume (<75, 75-400, >400 mL). Diagnoses of malignant pleural effusion (MPE) served as controls. RESULTS: We identified 90 patients, with a mean age of 60.6 years. Diagnoses included suspicious for involvement by carcinoma/adenocarcinoma in 64.4%, leukemia/lymphoma in 15.6%, melanoma in 2.2%, sarcoma in 3.3%, germ cell tumor in 1.1%, and not otherwise specified in 13.3%. Immunostains were performed in 47.8% and considered inconclusive in 24%. Average sample volume was 419 mL. There was a statistically significant difference between the SFM vs MPE groups for volumes greater than 75 mL (P = .001, χ 2 test), with SFM having increased proportion of volumes  greater than 400 mL, compared with the MPE group. There was no statistically significant difference in mean overall survival when the groups were compared (P = .49). CONCLUSIONS: Samples with low cellularity, scant cell blocks, and inconclusive immunostains may contribute to a suspicious category diagnosis in pleural effusions.


Assuntos
Adenocarcinoma/diagnóstico , Linfoma/diagnóstico , Derrame Pleural Maligno/diagnóstico , Derrame Pleural/patologia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Citodiagnóstico , Feminino , Humanos , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Derrame Pleural Maligno/patologia , Sensibilidade e Especificidade , Adulto Jovem
6.
Am J Med Sci ; 360(3): 236-242, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32423747

RESUMO

BACKGROUND: The etiology of pleural effusions often remained unknown notwithstanding surgical pleural biopsy and further clinical observation. A better understanding of clinical characteristics of patients with idiopathic pleural effusion (IPE) may improve the ability to differentiate between IPEs and cytology-negative malignant pleural effusions (MPEs) and facilitate the identification of patients requiring invasive investigation. However, little is known about the clinical factors that can help distinguish patients with IPE from those with cytology-negative MPE. MATERIALS AND METHODS: Patients who were diagnosed with IPE or cytology-negative MPE between 2010 and 2017 were enrolled in this retrospective study. Clinical, laboratory and radiologic characteristics were compared between patients with IPE and cytology-negative MPE. Diagnostic performances of predictors for IPE were assessed using receiver operating characteristic curves. RESULTS: Of 146 patients undergoing pleural biopsy owing to cytology-negative pleural effusion of uncertain cause, MPE was confirmed in 54 patients. IPE was ultimately diagnosed in 22 patients. Multivariate analysis demonstrated that a minimal amount of pleural effusion (odds ratio [OR] = 12.41, P = 0.039), presence of pleural nodularity (OR = 0.01, P < 0.001) and pleural fluid carcinoembryonic antigen levels less than 14 ng/mL (OR = 87.59, P = 0.002) were independent factors for distinguishing IPEs from cytology-negative MPEs. A combination of the absence of pleural nodularity with pleural fluid carcinoembryonic antigen levels less than 14 ng/mL yielded an area under the curve of 0.94 (sensitivity = 91% and specificity = 96%). CONCLUSIONS: Using these readily available parameters to identify IPE in patients with cytology-negative exudative effusion of unknown cause can help guide decision-making when choosing to perform an invasive pleural biopsy or to take a conservative approach.


Assuntos
Derrame Pleural Maligno/diagnóstico , Derrame Pleural/diagnóstico , Idoso , Biópsia , Antígeno Carcinoembrionário/análise , Diagnóstico Diferencial , Exsudatos e Transudatos/química , Exsudatos e Transudatos/citologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/patologia , Derrame Pleural Maligno/patologia , Curva ROC , Radiografia Torácica , Estudos Retrospectivos , Toracentese , Toracoscopia , Tomografia Computadorizada por Raios X
7.
Acta Cytol ; 64(5): 477-485, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32422631

RESUMO

INTRODUCTION: The International System for Reporting Serous Fluid Cytopathology (ISRSFC) has recently been announced. Pericardial effusion (PE) is a clinical manifestation of a large variety of both neoplastic and non-neoplastic conditions. Herein, we have applied the ISRSFC on reporting PE cytopathology and report our experience in a large academic institution. METHOD AND MATERIALS: After the Institutional Research Board approval, the electronic pathology database of a large academic institution was queried for PEs collected from January 2014 to January 2019. The diagnosis, patient demographics, and specimen volume were recorded for each case. The ISRSFC was applied and the cases were divided into 5 categories: nondiagnostic (ND), negative for malignancy (NFM), atypia of uncertain significance (AUS), suspicious for malignancy (SFM), and malignant (MAL). Each category was evaluated separately. RESULTS: A total of 299 cases were identified, 162 females and 137 males. The age of the subjects ranged from less than a year to 89 years (average 51.25 years). The volume ranged from 3 to 1,700 mL (average 298 mL). There were 252 NFM (84.3%), 13 AUS (4.3%), 4 SFM (1.3%), and 30 MAL (10%) cases. Metastatic lung cancer followed by metastatic breast cancer were the most common malignancies involving pericardial fluid (PF). No cases were diagnosed as ND. However, no mesothelial cells were seen in 97 specimens (38% of the negative cases). None of these patients developed malignant PE in at least 6 months of follow-up. CONCLUSION: The ISRSFC is a user-friendly reporting system which is easily applicable on serous fluid including PF. The vast majority of PEs was benign (84.3%). Our study shows that the presence of mesothelial cells is not necessary for specimen adequacy in serous effusions as no mesothelial cells were identified in 38% of the negative cases. Metastatic lung carcinoma was the most common diagnosis of malignant effusions.


Assuntos
Citodiagnóstico/métodos , Citodiagnóstico/normas , Neoplasias Pulmonares/complicações , Neoplasias/complicações , Derrame Pleural Maligno/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/metabolismo , Prognóstico , Adulto Jovem
8.
Cancer Invest ; 38(6): 356-364, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32468861

RESUMO

Pleural effusion adenosine deaminase (ADA) levels are elevated in various diseases. We investigated whether pleural effusion ADA levels differ among patients with malignant pleural mesothelioma (MPM), lung cancer (LC), and benign diseases, including tuberculous pleurisy. We examined 329 patients from February 2002 to July 2013. There were 131 MPM cases with ADA levels of 32.29 IU/L; 117 LC cases with ADA levels of 21.12 IU/L; 54 benign disease cases with ADA levels of 20.98 IU/L. A significant difference existed in pleural effusion ADA levels between MPM and benign disease patients. Pleural effusion ADA levels were significantly higher in MPM patients.


Assuntos
Adenosina Desaminase/genética , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Neoplasias/diagnóstico , Neoplasias Pleurais/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma/diagnóstico por imagem , Mesotelioma/genética , Mesotelioma/patologia , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/patogenicidade , Neoplasias/diagnóstico por imagem , Neoplasias/genética , Neoplasias/patologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/diagnóstico por imagem , Derrame Pleural Maligno/genética , Derrame Pleural Maligno/patologia , Neoplasias Pleurais/diagnóstico por imagem , Neoplasias Pleurais/genética , Neoplasias Pleurais/patologia , Toracoscopia , Tuberculose Pleural/diagnóstico , Tuberculose Pleural/genética , Tuberculose Pleural/microbiologia , Tuberculose Pleural/patologia
9.
Rev. esp. patol. torac ; 32(2): 118-124, mayo 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193904

RESUMO

La survivina se encuentra sobre-expresada en tumores, y podría ser un buen biomarcador diagnóstico y pronóstico en derrames pleurales malignos. OBJETIVO: estudiar la concentración de survivina en pacientes con derrame pleural maligno sometidos a pleurodesis con talco, relacionarla con el resultado de ésta y comparar sus resultados con otros marcadores como pH, glucosa y LDH en líquido pleural. MÉTODOS: se han incluido 84 pacientes con derrame pleural maligno (32 con cáncer de mama, 25 de pulmón y 27 mesoteliomas) sometidos a toracoscopia y pleurodesis con talco. Se recogieron muestras de líquido pleural antes (basal) y 24 horas después de la pleurodesis, y en ellas se midieron los niveles de survivina, pH, glucosa y LDH. También se estudió la carga tumoral en la pleura y la re-expansión del pulmón tras la toracoscopia y pleurodesis.R RESULTADOS: la presencia de niveles basales de survivina > 30 pg/mL se asoció a alto índice de fracaso de la pleurodesis (p = 0,002), y superó en poder predictivo a pH (p = 0,004), glucosa (p = 0,005) y LDH (p = 0,013) CONCLUSIÓN: la survivina juega un poderoso papel como marcador pronóstico en derrames pleurales malignos, y se suma a otros marcadores clásicos como pH, glucosa y LDH, que están asociados a la agresividad tumoral


Survivin is found to be overexpressed in tumors and could be a good diagnostic and prognostic biomarker in malignant pleural effusions. OBJECTIVE: To study the concentration of survivin in patients with a malignant pleural effusion who undergo pleurodesis with talc, associate it with the result of the procedure and compare the results with other markers like pH, glucose and LDH in pleural liquid. METHODS: 84 patients with malignant pleural effusion (32 with breast cancer, 25 lung cancer and 27 mesotheliomas) who underwent thoracoscopy and pleurodesis with talc were included in the study. Pleural liquid samples were taken before (baseline) and 24 hours after the pleurodesis, measuring the levels of survivin, pH, glucose and LDH. The tumor burden in the pleura and the re-expansion of the lung after thoracoscopy and pleurodesis were also studied. RESULTS: The presence of baseline levels of survivin >30 pg/mL was associated with a high rate of pleurodesis failure (p = 0.002) and surpassed the predictive power of pH (p = 0.004), glucose (p = 0.005) and LDH (p = 0.013). CONCLUSION: Survivin plays a powerful role as a prognostic marker in malignant pleural effusions and joins other classic markers like pH, glucose and LDH, which are associated with tumor aggression


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Survivina/análise , Pleurodese/métodos , Talco/uso terapêutico , Carga Tumoral , Derrame Pleural Maligno/diagnóstico , Talco/imunologia , Derrame Pleural/terapia , Toracoscopia , Derrame Pleural Maligno/patologia , Ensaio de Imunoadsorção Enzimática , Curva ROC
10.
Sci Rep ; 10(1): 5679, 2020 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-32231227

RESUMO

Discriminating between malignant pleural effusion (MPE) and benign pleural effusion (BPE) remains difficult. Thus, novel and efficient biomarkers are required for the diagnosis of pleural effusion (PE). The aim of this study was to validate calprotectin as a diagnostic biomarker of PE in clinical settings. A total of 425 patients were recruited, and the pleural fluid samples collected had BPE in 223 cases (53.7%) or MPE in 137 patients (33%). The samples were all analysed following the same previously validated clinical laboratory protocols and methodology. Calprotectin levels ranged from 772.48 to 3,163.8 ng/mL (median: 1,939 ng/mL) in MPE, and 3,216-24,000 ng/mL in BPE (median: 9,209 ng/mL; p < 0.01), with an area under the curve of 0.848 [95% CI: 0.810-0.886]. For a cut-off value of ≤ 6,233.2 ng/mL, we found 96% sensitivity and 60% specificity, with a negative and positive predictive value, and negative and positive likelihood ratios of 96%, 57%, 0.06, and 2.4, respectively. Multivariate analysis showed that low calprotectin levels was a better discriminator of PE than any other variable [OR 28.76 (p < 0.0001)]. Our results confirm that calprotectin is a new and useful diagnostic biomarker in patients with PE of uncertain aetiology which has potential applications in clinical practice because it may be a good complement to cytological methods.


Assuntos
Complexo Antígeno L1 Leucocitário/análise , Derrame Pleural Maligno/diagnóstico , Derrame Pleural/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores Tumorais/análise , Diagnóstico Diferencial , Feminino , Humanos , Complexo Antígeno L1 Leucocitário/metabolismo , Masculino , Pessoa de Meia-Idade , Pleura/patologia , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Espanha/epidemiologia
11.
Medicine (Baltimore) ; 99(10): e19320, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150067

RESUMO

Pleural effusion (PE) remains insurmountable challenge and public health problem, requiring novel noninvasive biomarkers for accurate diagnosis. The aim of this study was to assess the clinical significance of apolipoprotein E (Apo-E) in PE, in order to determine its potential use as a diagnostic biomarker for malignant PE (MPE).PE samples were obtained from 127 patients and the etiology of PE was determined by multiple diagnostic techniques. Apo-E levels were then measured in the pleural fluid samples.58 PE patients were diagnosed with tumors, while 69 were tumor-free. Apo-E levels in MPE patients were significantly higher than those with benign PE (BPE) (P < .05). An Apo-E cut-off of 69.96 ng/mL yielded sensitivity and specificity of 79.31% and 73.91% respectively for MPE detection. The area under the curve for Apo-E was 0.793 (95% confidence interval: 0.712 to 0.860), which was smaller than that of carcinoembryonic antigen (CEA) (Z = 2.081, P<.05). In addition, the combination of Apo-E and CEA detection yielded a higher sensitivity of 87.90% and specificity of 95.65% in diagnosing MPE.In conclusion, Apo-E levels in PE may be a potential biomarker for the detection of MPE. The combined detection of Apo-E and CEA could improve the diagnostic sensitivity and specificity for MPE. These findings provide a simple and convenient method for clinical screening and detection of PE.


Assuntos
Apolipoproteínas E/metabolismo , Derrame Pleural Maligno/diagnóstico , Biomarcadores Tumorais/metabolismo , Exsudatos e Transudatos/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural Maligno/metabolismo , Sensibilidade e Especificidade
12.
Anticancer Res ; 40(2): 1135-1139, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014965

RESUMO

BACKGROUND/AIM: The purposes of this study were to evaluate the usefulness of chest computed tomographic (CT) scan plus pleural fluid cytology (PFC) together in patients with malignant pleural effusion (PE), and to compare the results of these diagnostic tools in patients with malignant PE due to non-small-cell lung cancer and pulmonary metastases from other malignancies. PATIENTS AND METHODS: The medical records of 185 patients with PE, who underwent chest CT, PFC and video-assisted thoracoscopy (VATS) thoracentesis followed by VATS-guided biopsy for diagnostic purpose, were reviewed. At the final diagnosis, 123 (66.5%) patients had malignant PE (cases), and 62 (33.5%) had benign PE (controls). RESULTS: Overall, the sensitivity, specificity, and accuracy of CT and PFC were 65.0% vs. 67.5% 98.4% vs. 98.4%, and 76.2% vs. 77.8%, respectively. The combination of CT plus PFC significantly improved sensitivity (86.2%, p=0.003) and accuracy (90.8%, p=0.02). CONCLUSION: CT and PFC used together may lead to approximately 100% specificity and >90% sensitivity in distinguishing between benign and malignant PE.


Assuntos
Citodiagnóstico , Derrame Pleural Maligno/diagnóstico , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Estudos de Casos e Controles , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade
13.
Postgrad Med ; 132(5): 406-411, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32077354

RESUMO

BACKGROUND: Patients with undiagnostic pleural effusions are routinely examined by conventional medical thoracoscopy under the white light (WL). The endoscopic appearance of pleural diseases under WL could be misleading. Narrow-Band Imaging (NBI) has been applied as an interesting and effective diagnostic tool for endoscopy. However, there is also controversy about its value in the application of thoracoscopy. OBJECTIVE: The objective of this study was to investigate the diagnostic value of NBI technology during thoracoscopy. METHODS: Patients with undiagnosed pleural effusions admitted to our hospital between September 2017 and September 2019 were enrolled. During the thoracoscopy, we performed WL mode first and then NBI. Pictures of endoscopic real-time lesions were recorded under two modes, and at least five pieces of tissue were taken, respectively, on pleura lesions. Biopsy specimens were respectively taken for pathologic analysis. Diagnostic sensitivity, specificity were calculated to compare with pathologic results. RESULTS: 100 eligible patients were enrolled, including 63 with malignancy, 23 with tuberculous pleurisy, 3 with systemic disease and 11 with the negative condition. Compared with pathological results, the sensitivity of WL was 91.01%, and NBI 84.27%; while the specificity of WL was 27.27%, and NBI 81.82%. Compared NBI with WL, the former's specificity is superior to the latter's, which is statistically significant (P < 0.05). CONCLUSIONS: The advantage of NBI lies in its high specificity. It's useful to diagnose unknown pleural effusions in clinical practice. With better visualization of blood vessels, we can enhance the accuracy of biopsy and reduce the risk of unexpected bleeding arose from the biopsy.


Assuntos
Imagem de Banda Estreita/métodos , Doenças Pleurais/diagnóstico , Doenças Pleurais/patologia , Toracoscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/diagnóstico por imagem , Derrame Pleural/diagnóstico , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/patologia , Sensibilidade e Especificidade , Tuberculose Pleural/diagnóstico , Tuberculose Pleural/patologia , Adulto Jovem
14.
Acta Cytol ; 64(3): 248-255, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31352449

RESUMO

BACKGROUND: Differentiating reactive mesothelial cells from metastatic carcinoma in effusion cytology is a challenging task. The application of at least 4 monoclonal antibodies including 2 epithelial markers (Ber-EP4, MOC-31, CEA, or B72.3) and 2 mesothelial markers (calretinin, WT-1, CK5/6, or HBME-1) are often useful in this distinction; however, it is not readily available in many resource-limited developing countries. Aberrant immunoexpression of enhancer of zeste homolog 2 (EZH2), a transcriptional repressor involved in cancer progression, is observed widely in various malignancy. In this study, we evaluate the diagnostic value of EZH2 as a single reliable immunomarker for malignancy in effusion samples. METHODS: A total of 108 pleural, peritoneal, and pericardial effusions/washings diagnosed as unequivocally reactive (n = 41) and metastatic carcinoma (n = 67) by cytomorphology over 18 months were reviewed. Among the metastatic carcinoma cases, 54 were adenocarcinoma and others were squamous cell carcinoma (n = 1), carcinosarcoma (n = 1), and carcinoma of undefined histological subtypes (n = 11). Cell block sections were immunostained by EZH2 (Cell Marque, USA). The percentages of EZH2-immunolabeled cells over the total cells of interest were calculated. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off score to define EZH2 immunopositivity. RESULTS: A threshold of 8% EZH2-immunolabeled cells allows distinction between malignant and reactive mesothelial cells, with 95.5% sensitivity, 100% specificity, 100% positive predictive value, and 93.2% negative predictive value (p < 0.0001). The area under the curve was 0.988. CONCLUSION: EZH2 is a promising diagnostic biomarker for malignancy in effusion cytology which is inexpensive yet trustworthy and could potentially be used routinely in countries under considerable economic constraints.


Assuntos
Líquido Ascítico/patologia , Biomarcadores Tumorais/análise , Carcinoma/diagnóstico , Proteína Potenciadora do Homólogo 2 de Zeste/análise , Derrame Pericárdico/diagnóstico , Derrame Pleural Maligno/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Líquido Ascítico/química , Carcinoma/complicações , Citodiagnóstico/métodos , Feminino , Humanos , Imuno-Histoquímica/métodos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/etiologia , Derrame Pleural Maligno/etiologia , Estudos Retrospectivos , Adulto Jovem
15.
Acta Cytol ; 64(3): 256-264, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31466063

RESUMO

BACKGROUND: Effusion cytology is a major diagnostic tool in medicine and has both therapeutic and prognostic implications. One of the dilemmas encountered is the differentiation between atypical cells and reactive mesothelial cells. The use of ancillary tools can reduce this grey zone and help to achieve a definitive diagnosis. OBJECTIVES: The main objective of this study was to evaluate the role of flow cytometry (FCM) and cell block with immunohistochemistry (IHC), along with the clinicoradiological investigations, to achieve a final diagnosis in effusion cytology to the maximum extent possible. METHOD: A prospective study was conducted. Effusion fluids, showing adequate amount and cellularity, were processed for conventional cytology, ploidy analysis by FCM, and cell block analysis, followed by IHC wherever required. Conventional cytological analysis was done by 2 independent pathologists, to look for interobserver variation, if any. The final result was achieved on the basis of integration of the results of the aforementioned studies, cytological details, clinicoradiological information, tissue biopsy findings, and follow-up. RESULT: A total of 90 samples were analyzed. On cytological examination, observer I categorized 60% samples as benign and 18.8% (n = 17) as malignant versus 58% categorized as benign and 23.3% (n = 21) as malignant by observer II. Observer I reported 19 (21.1%) equivocal cases and observer II reported 16 (17.7%). When both pathologists were considered together, the number of equivocal cases increased to 20. Sensitivity and specificity of FCM were 96.67 and 100%, respectively, and 100% for the cell block. On combining all techniques, the equivocal cases were resolved and a total of 33 cases were reported as malignant. However, 3 cases could still not be categorized and were labeled inconclusive. CONCLUSION: Conventional cytology combined with cell block IHC and FCM has the potential to minimize the requirement of tissue biopsy for confirmation. If the first sample is used judiciously for all the techniques, this may reduce the requirement for a second sample and possibly also the time required for a definite diagnosis and the initiation of therapy.


Assuntos
Líquido Ascítico/patologia , Citodiagnóstico/métodos , DNA de Neoplasias/análise , Neoplasias/diagnóstico , Ploidias , Citometria de Fluxo , Humanos , Imuno-Histoquímica/métodos , Neoplasias/genética , Derrame Pericárdico/diagnóstico , Derrame Pleural Maligno/diagnóstico , Sensibilidade e Especificidade
16.
Acta Cytol ; 64(4): 352-359, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31597129

RESUMO

INTRODUCTION: In effusion cytology, immunocytochemistry is a useful staining approach to provide important information for diagnosis. Effusion cytology is performed not only for pleural effusions and ascites but also for peritoneal and needle washing from fine needle aspirations or instruments. Although various solutions are used for washing cytology, the effect of the solution type on immunocytochemical reactivity is not fully understood. In this study, we examined the immunocytochemical reactivity of cytological samples after storage in various solutions. METHODS: Cell block specimens were obtained from ascites of patients with peritoneal cancer and pleural effusions of patients with diffuse malignant mesothelioma. Various solutions, including physiological saline (PS), Ringer solution, a low-molecular-weight dextran L injection, Voluven 6% solution, Mixid L injection, RPMI-1640 medium, and horse serum were added to the sediment layers of aliquots. All samples were kept at 4°C, and aliquots were subsequently processed at specific time points (0, 1, 2, 4, 7, and 14 days). Formalin-fixed, paraffin-embedded, cell block samples were prepared for immunocytochemical staining. Immunocytochemical results were analyzed for differences in the percentages of positive cells, using the effusion sample stored for 1 h as standard (100%). RESULTS: For all solutions other than PS, the median and central 50% of values were <100% (with respect to the effusion sample as a standard) after 1 h of storage. Immunoreactivity decreased for most solutions as time progressed. CONCLUSION: Of note, immunocytochemistry results obtained using a washing solution are different from those using an effusion sample. For cytology, when a washing solution was used or when a sample was stored for a long time, the accuracy of the immunocytochemical results was low.


Assuntos
Citodiagnóstico/métodos , Soluções/química , Feminino , Humanos , Imuno-Histoquímica/métodos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma/diagnóstico , Mesotelioma/patologia , Derrame Pleural/diagnóstico , Derrame Pleural/patologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/patologia
17.
J Pediatr Hematol Oncol ; 42(1): 74-78, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30044355

RESUMO

Kaposiform hemangioendothelioma (KHE) is a rare infiltrative vascular tumor that may be associated with Kasabach-Merritt Phenomenon (KMP), which is a consumptive coagulopathy with potentially life-threatening thrombocytopenia. Management of KHE and KMP is challenging, and currently, there are no standardized validated treatment protocols. Mammalian target of rapamycin inhibitors have been shown to be effective in the treatment of KHE. We describe a term male who presented as a diagnostic dilemma with life-threatening pleural and pericardial effusions and severe thrombocytopenia. After extensive work-up the etiology for his condition was determined to be KHE with KMP. The patient was commenced on sirolimus and responded well to therapy with resolution of KMP.


Assuntos
Hemangioendotelioma/tratamento farmacológico , Síndrome de Kasabach-Merritt/tratamento farmacológico , Derrame Pericárdico/tratamento farmacológico , Derrame Pleural Maligno/tratamento farmacológico , Sarcoma de Kaposi/tratamento farmacológico , Sirolimo/administração & dosagem , Hemangioendotelioma/diagnóstico , Humanos , Recém-Nascido , Síndrome de Kasabach-Merritt/diagnóstico , Masculino , Derrame Pericárdico/diagnóstico , Derrame Pleural Maligno/diagnóstico , Sarcoma de Kaposi/diagnóstico
18.
Proteomics Clin Appl ; 14(1): e1900001, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31715074

RESUMO

PURPOSE: To identify potential protein biomarkers for distinguishing tuberculosis plural effusion (TBPE) from malignant plural effusion (MPE). EXPERIMENTAL DESIGN: Five independent samples from each group (TBPE and MPE) are enrolled for label-free quantitative proteomics analyses. The differentially expressed proteins are validated by western blot and ELISA. Logistic regression analysis is used to obtain the optimal diagnostic model. RESULTS: In total, 14 proteins with significant difference are identified between TBPE and MPE. Seven differentially expressed proteins are validated using western blot, and the expression patterns of these seven proteins are similar with those in proteomics analysis. Statistically significant differences in four proteins (AGP1, ORM2, C9, and SERPING1) are noted between TBPE and MPE in the training set (n = 230). Logistic regression analysis shows the combination of AGP1-ORM2-C9 presents a sensitivity of 73.0% (92/126) and specificity of 89.4% (93/104) in discriminating TBPE from MPE. Additional validation is performed to evaluate the diagnostic model in an independent blind testing set (n = 80), and yielded a sensitivity of 74.4% (32/43) and specificity of 91.9% (34/37) in discriminating TBPE from MPE. CONCLUSION: The study uncovers the proteomic profiles of TBPE and MPE, and provides new potential diagnostic biomarkers for distinguishing TBPE from MPE.


Assuntos
Derrame Pleural Maligno/genética , Derrame Pleural/genética , Proteoma/genética , Tuberculose/genética , Biomarcadores Tumorais/genética , Diagnóstico Diferencial , Feminino , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas de Neoplasias/genética , Derrame Pleural/diagnóstico , Derrame Pleural/patologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/patologia , Proteômica , Tuberculose/diagnóstico , Tuberculose/patologia
19.
Cancer Cytopathol ; 128(2): 126-132, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31821740

RESUMO

BACKGROUND: The separation of benign from malignant mesothelial proliferations on effusion cytology can be difficult. Loss of methylthioadenosine phosphorylase (MTAP) by immunohistochemistry is an established marker of malignancy in mesothelial proliferations, but to the authors' knowledge largely has been applied only to biopsies. The current study was conducted to determine the usefulness of MTAP immunohistochemistry in the diagnosis of malignant mesothelioma in effusion cytology specimens. METHODS: A total of 21 effusion cytology cases of malignant mesothelioma were stained for MTAP and BRCA-associated protein 1 (BAP1), with 15 reactive mesothelial cytology cases used as a control. Fourteen cases had a paired surgical specimen for comparison, and 7 cases were run for CDKN2A deletion by fluorescence in situ hybridization. RESULTS: Complete loss of MTAP cytoplasmic staining was noted in 7 of 21 effusion samples (33%), and no loss was observed in 11 effusion samples (52%); 11 of these cases had a matching surgical specimen and all 11 specimens demonstrated the same MTAP pattern. Partial loss was observed in 3 effusion specimens (80%, 40%, and 40% intact staining, respectively), but in all 3 the surgical specimen demonstrated 100% staining. None of the 15 reactive mesothelial cytology specimens demonstrated MTAP cytoplasmic loss. CDKN2A FISH demonstrated concordance in 5 of 7 cases (71%). MTAP immunohistochemistry had a sensitivity of 33% and a specificity of 100% for this differential diagnosis. CONCLUSIONS: MTAP staining demonstrated generally good concordance between the cytologic and surgical specimens and appears to be useful in the diagnosis of mesothelioma on effusion specimens. Complete loss of MTAP is a reliable marker of malignancy, but the significance of partial loss of MTAP staining is unclear.


Assuntos
Biomarcadores Tumorais/análise , Imuno-Histoquímica , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Derrame Pleural Maligno/diagnóstico , Purina-Núcleosídeo Fosforilase/análise , Proteínas Supressoras de Tumor/análise , Ubiquitina Tiolesterase/análise , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Biópsia , Inibidor p16 de Quinase Dependente de Ciclina/análise , Inibidor p16 de Quinase Dependente de Ciclina/genética , Deleção de Genes , Humanos , Hibridização in Situ Fluorescente , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Mesotelioma/genética , Mesotelioma/patologia , Mesotelioma/cirurgia , Cavidade Pleural/patologia , Derrame Pleural Maligno/genética , Derrame Pleural Maligno/patologia , Derrame Pleural Maligno/cirurgia , Purina-Núcleosídeo Fosforilase/metabolismo , Proteínas Supressoras de Tumor/metabolismo , Ubiquitina Tiolesterase/metabolismo
20.
Medicine (Baltimore) ; 98(48): e18251, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770288

RESUMO

RATIONALE: Small cell carcinoma (SCC) occurs mostly in the lung, and small cell lung cancer accounts for 13% of newly diagnosed lung cancers. Only 2.5% of SCC occurs in extrapulmonary sites, and SCC of pleural origin is especially very uncommon. PATIENT CONCERNS: An 85-year-old man presenting with progressive dyspnea for more than 7 days. DIAGNOSES: Computed tomography scan of the chest showed massive pleural effusion and diffuse nodular thickening of the pleura on the right chest. Sonography-guided needle biopsy of the pleural mass was performed and histologic and immunohistochemical findings revealed SCC. Since no parenchymal lung lesion was observed, the patient was finally diagnosed with SCC of the pleura (SCCP). INTERVENTIONS: Due to the patient's old age and poor performance status, chemotherapy was not performed and only drainage of pleural effusion was conducted for symptom relief. OUTCOMES: Dyspnea improved after pleural effusion drainage. The patient was discharged and transferred to a local medical center for hospice care. LESSONS: Although primary SCCP is extremely rare, SCCP should also be considered as well as mesothelioma in case of presence of a pleural-based mass with massive pleural effusion.


Assuntos
Carcinoma de Células Pequenas , Dispneia , Derrame Pleural Maligno , Neoplasias Pleurais , Toracentese/métodos , Idoso de 80 Anos ou mais , Carcinoma de Células Pequenas/complicações , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Pequenas/fisiopatologia , Dispneia/diagnóstico , Dispneia/etiologia , Cuidados Paliativos na Terminalidade da Vida , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Pleura/diagnóstico por imagem , Pleura/patologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/fisiopatologia , Derrame Pleural Maligno/terapia , Neoplasias Pleurais/complicações , Neoplasias Pleurais/patologia , Neoplasias Pleurais/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos
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