Non‐specific pleuritis in patients with active malignancy. Issue 2 (12th October 2017)

• Record Type: Journal Article
• Authors: Vakil, Erik; Ost, David; Vial, Macarena R.; Stewart, John; Sarkiss, Mona G.; Morice, Rodolfo C.; Casal, Roberto F.; Eapen, Georgie A.; Grosu, Horiana B.
• Is Part Of: Respirology. Volume 23:Issue 2(2018)
• Page Start: 213
• Page End: 219
• Publication Date: 2017-10-12
• Subjects: malignant pleural effusion -- pleural endoscopy -- pleuritis -- pleuroscopy -- pulmonary eosinophilia; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.13187
• Languages: English
• ISSNs: 1323-7799

Abstract

ABSTRACT: Background and objective: Pleuroscopy is the test of choice for patients with suspected malignant pleural effusion and negative cytology. Biopsies negative for malignancy are frequently attributed to non‐specific pleuritis, which poses a dilemma in patients with a known active malignancy, raising concern for a false‐negative result. Our primary objective was to determine the outcomes of patients with active malignancy who had a non‐malignant diagnosis on pleuroscopy. Methods: Retrospective review of all pleuroscopy cases from January 2005 to January 2015 at our institution was conducted. Biopsies were categorized by histopathology as malignant, eosinophilic or non‐specific pleuritis. Malignant histopathology was considered a true positive. Eosinophilic or non‐specific pleuritis was categorized as malignant, if malignancy was later identified during follow‐up, or chemotherapy induced, possible radiation induced, other paramalignant, other benign or idiopathic. Results: Of the 199 pleuroscopy cases reviewed, 172 (86%) had a history of active malignancy. On histopathology, 73 (42%) had malignancy, 9 (5%) had eosinophilic pleuritis and 90 (52%) had non‐specific pleuritis. Three patients with non‐specific pleuritis were diagnosed with malignancy at follow‐up. Pleuritis in 24 patients was chemotherapy induced, 27 were possibly radiation induced, 11 were other paramalignant and 3 were other benign. Idiopathic pleuritis was diagnosed in 31 patients. Patients were monitored for a mean of 23 ± 11 months. Conclusion: The prevalence of malignant pleural disease was lower than expected for our patient population. Patients with no malignancy on histopathology were most likely to have non‐specific pleuritis, a cause for which was identified in a majority of patients after clinical review. Abstract : See related Editorial Non‐specific pleuritis diagnosed on pleuroscopy in patients with active malignancy and pleural effusion represents a diagnostic dilemma. We studied outcomes in 199 patients with active malignancy who underwent pleuroscopy. The sensitivity of pleuroscopy was high and most patients without malignancy had non‐specific pleuritis, which was later categorized after clinical review.