Comparative Evaluation of Pleural Fluid Cytology and Pleural Histopathology in the Diagnosis of Malignant Pleural Effusion

K B Gupta; Sunaina Kharb; Dhruva Chaudhary; Dr Rajeev Sen; Dr Gaurav Punia

K B Gupta Senior Prof & Head, Department of Respiratory Medicine
Sunaina Kharb Post Graduate Student, Department of Respiratory Medicine
Dhruva Chaudhary Senior Prof & Head, Department of Pulmonary and Critical Care Medicine
Dr Rajeev Sen Senior Prof & Head, Department of Pathology, Pt B D Sharma Post Graduate Institute of Medical Health Sciences, Rohtak, Haryana, India
Dr Gaurav Punia Senior Resident Department PGIMS Rohtak

Keywords: Closed pleural biopsy, thoracoscopic pleural biopsy, sensitivity, pleural fluid cytology, istopathology

Abstract

Aims And Objectives: Both pleural fluid cytology and biopsy are done frequently to diagnose malignant pleural effusion but which is better is still unclear as both have advantages and disadvantages over each other. Choosing pleural histopathology done by closed pleural biopsy or thoracoscopy at the earliest can be a wise option to avoid delay in diagnosis of malignant pleural effusion. This study aims to evaluate diagnostic accuracy and yield of pleural fluid cytology and pleural biopsy in the diagnosis of malignant pleural effusion, and the role of immune histo-chemistry markers in the diagnosis of malignant pleural effusion. Material And Methods: The study was conducted in 60 patients suspected to have malignant pleural effusion. Pleural fluid cytology was sent on three consecutive days for malignant cells along with pleural biopsy on day 1. Thoracoscopy guided pleural biopsy has been done as needed. Results: 60 patients were included in the study with mean age 59.70±14.61yrs (25-86). Pleural fluid cytology was positive in 26 (43.3%) , closed pleural biopsy in 46 (76.6%), and total biopsy was positive in 51(85%) patients. So closed pleural biopsy had increased yield of 20 (33.30%) (p value=0.0098) over pleural fluid cytology and increased yield of total biopsy over cytology was 25 (41.70%). Conclusion: Sensitivity of pleural fluid cytology was 43.33% as compared to 85% for pleural histopathology (closed and thoracoscopy biopsy) in this study which is suggestive of superiority of tissue sampling as compared to fluid samples.