Role of biochemistry, cytology, and biopsy in the etiological diagnosis of pleural effusion- a clinical study
Abstract
Introduction:Pleural effusion is the most common pleural disorder. It refers to excessive or abnormal accumulation of fluid in the pleural space. It is a commonly occurring medical problem caused by various pathological conditions. To treat patients appropriately, it is important to establish an accurate etiological diagnosis.
Material and Method: This is an observational study conducted at a tertiary health care center. The pleural effusion was assessed clinically, biochemically, bacteriologically, cytologically, and histopathologically.
Result: Tuberculosis was the most common etiology, followed by malignancy. A pleural biopsy was done in 70 patients. Pleural tissue was obtained in 65 cases. On histopathology,Malignancy was diagnosed in 15, tuberculosis in 35, and non-specific inflammation in 13 cases. Out of 35 histological proven tuberculosis cases, 26 cases had adenosine de-aminase (ADA) more than 70 u/l.
Conclusion:Every pleural effusion is not due to tuberculosis but can be due to other causes, malignancy should always be excluded. Pleural fluid cytology and biopsy can give a definite diagnosis in a significant number of cases of pleural effusion. Tuberculosis is still the most common cause of pleural effusion followed by malignancy.
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References
Light RW. Pleural diseases. 6th ed.Philadelphia: Lippincott Williams & Wilkins; 2013
Storey DD, Dines DE, Coles DT. Pleural effusion. A diagnostic dilemma. JAMA. 1976;236(19):2183-2186. doi: 10.1001/jama.1976.03270200021022.
Light RW. Approach to the patient: In pleural diseases. Lippincort Williams and Wilkings.4th ed,2001;pp. 182-195.
Light RW.Disorders of the pleura, mediastinum, diaphragm and chest wall.In Harrisons Principles of Internal Medicine; 16th ed, McGraw-Hill; 2005, p. 1566.
Choi H, Chon HR, Kim K, Kim S, Oh KJ, Jeong SH, et al. Clinical and laboratory differences between lymphocyte-and neutrophil-predominant pleural tuberculosis. PLoS One. 2016;11(10):e0165428. doi: https://dx.doi.org/10.1371%2Fjournal.pone.0165428.
Reddy DJ, Indira C. Needle biopsy of parietal pleura in the etiological diagnosis of pleural effusion. J Indian Med Assoc. 1963;40:6-7.
Pandit S, Chaudhuri AD, Datta SB, Dey A, Bhanja P. Role of pleural biopsy in etiological diagnosis of pleural effusion. Lung India. 2010;27(4):202-204. Available from: http://www.lungindia.com/text.asp?2010/27/4/202/71941.
Chernow B, Sahn SA. Carcinomatous involvement of pleural – an analysis of 96 pateints. Am J Med. 1977;63(5):695-702. doi: https://doi.org/10.1016/0002-9343(77)90154-1.
Berger HW, Mejia E. Tuberculous pleurisy. Chest. 1973;63(1):88-92.doi: https://doi.org/10.1378/chest.63.1.88.
Yam LT. Diagnostic significance of lymphocytes in pleural effusion. Ann Intern Med. 1967;66(5):972-982. doi: https://doi.org/10.7326/0003-4819-66-5-972.
Morrone N, Algranti E. Pleural biopsy with Cope and Abrahm’s needles. Chest. 1987;92(6):1050-1052. doi: https://doi.org/10.1378/chest.92.6.1050.
Verma S, Dubey A, Singh B. Efficacy and safety of pleural biopsy in aetiological diagnosis of pleural effusion. Int J Inf Dis. 2009;7:1.
Mungal IP, Cowen PN. Multiple Pleural biopsy with Abram’s needle. Thorax. 1980;35(8):600-602. doi: https://doi.org/10.1136/thx.35.8.600.
Thiruvengadan KV, Anguli VC, Madanagopalan N. Etiological diagnosis of pleural effusion by punch biopsy of the parietal pleura. Chest. 1962;42(5):529-533.doi: https://doi.org/10.1378/chest.42.5.529.
Mangaraj M. Pleural fluid MDA and serum-effusion albumin gradient in pleural effusion. Indian J Clin Biochem. 2008;23:81-84. doi: https://doi.org/10.1007/s12291-008-0019-1.
Guisti G, Galanti B. Adenosine deaminase. In: Bergmeyer HU, editor. Methods of enzyme analysis. 3rd ed. New York: Academic Press; 1983. pp. 315-323.
Biswas B, Sharma SK, Negi RS, Gupta N, Jaswal VM, Niranjan N. Pleural effusion: Role of pleural fluid cytology, adenosine deaminase level, and pleural biopsy in diagnosis. J Cytol. 2016;33(3):159-162. Available from: http://www.jcytol.org/text.asp?2016/33/3/159/188062.
Ahmed JU, Hossain MD,AfrozF,Rahim MA, Musa AKM. Role of pleural biopsies in the etiological diagnosis of exudative pleural effusion. Bangladesh Crit Care J. 2017;5(1):33-36. doi: https://doi.org/10.1016/j.chest.2016.02.458.
Mishra AK, Verma SK, Kant S, Kushwaha RA, Garg R, Kumar S, Prakash V, Verma A, Sagar M. A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion. South Asian J Cancer. 2016;5(1):27-28. doi: https://doi.org/10.4103/2278-330X.179700.
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