When should malignancy be suspected in the evaluation of pleural effusion (fluid on the lungs)?

Updated: Dec 28, 2018
  • Author: Kamran Boka, MD, MS; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Malignancy is suspected in patients with known cancer or with lymphocytic, exudative effusions, especially when bloody. Direct tumor involvement of the pleura is diagnosed most easily by performing pleural fluid cytology.

Heparinized samples (1 mL of 1:1000 heparin per 50 mL of pleural fluid) should be submitted for analysis if the pleural fluid is bloody and they should be refrigerate if samples will not be processed within one hour.

The reported diagnostic yields in cytology vary from 60-90%, depending on the extent of pleural involvement and the type of primary malignancy. Cytology findings are positive in 58% of effusions related to mesothelioma.


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