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Jia, J. ; Marazioti, A.* ; Voulgaridis, A.* ; Psallidas, I.* ; Lamort, A.-S. ; Iliopoulou, M.* ; Krontira, A.C.* ; Lilis, I.* ; Asciak, R.* ; Kanellakis, N.I.* ; Rahman, N.M.* ; Karkoulias, K.* ; Spiropoulos, K.* ; Liu, R.* ; Kaiser, J.C. ; Stathopoulos, G.T.

Clinical identification of malignant pleural effusions.

Transl. Oncol. 39:101800 (2023)
DOI PMC
Creative Commons Lizenzvertrag
Open Access Gold as soon as Publ. Version/Full Text is submitted to ZB.
INTRODUCTION: Pleural effusions frequently signal disseminated cancer. Diagnostic markers of pleural malignancy at presentation that would assess cancer risk and would streamline diagnostic decisions remain unidentified. METHODS: A consecutive cohort of 323 patients with pleural effusion (PE) from different etiologies were recruited between 2013 and 2017 and was retrospectively analyzed. Data included history, chest X-ray, and blood/pleural fluid cell counts and biochemistry. Group comparison, receiver-operator characteristics, unsupervised hierarchical clustering, binary logistic regression, and random forests were used to develop the malignant pleural effusion detection (MAPED) score. MAPED was validated in an independent retrospective UK cohort (n = 238). RESULTS: Five variables showed significant diagnostic power and were incorporated into the 5-point MAPED score. Age > 55 years, effusion size > 50% of the most affected lung field, pleural neutrophil count 〈 2,500/mm3, effusion protein 〉 3.5 g/dL, and effusion lactate dehydrogenase > 250 U/L, each scoring one point, predicted underlying cancer with the area under curve(AUC) = 0.819 (P < 10-15) in the derivation cohort. The integrated discrimination improvement of MAPED scores showed an increase compared to cytology (p <0.001). Decision curve analysis indicated that the MAPED score generated net clinical benefit. In the validation dataset, the AUC of MAPED scores was 0.723 ( P = 3 × 10-9) for the MAPED score. Interestingly, MAPED correctly identified 33/42(79%) of cytology-negative patients that indeed had cancer. CONCLUSIONS: The MAPED score identifies malignant pleural effusions with satisfactory accuracy and can be used complementary to cytology to streamline diagnostic procedures. CONDENSED ABSTRACT: Diagnostic markers for malignant pleural effusions remain uncertain. The MAPED score identifies malignant pleural effusions and complements cytology and confers no additional risk to the patient or cost to the healthcare system.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Aging And Cancer ; Lactate Dehydrogenase ; Malignant Pleural Effusion Size ; Neutrophil ; Protein; Validation
e-ISSN 1936-5233
Journal Translational Oncology
Quellenangaben Volume: 39, Issue: , Pages: , Article Number: 101800 Supplement: ,
Publisher Neoplasia Press
Publishing Place Ste 800, 230 Park Ave, New York, Ny 10169 Usa
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Lung Health and Immunity (LHI)
Institute of Radiation Medicine (IRM)
Grants
German Center for Lung Research (Deutsches Zentrum fur Lungenforschung, DZL)
Target Validation Project for Pharmaceutical Development ALTERNATIVE of the German Ministry for Education and Research (Bundesministerium fur Bildung und Forschung, BMBF)
German Research Society (Deutsche Forschungsgemeinschaft, DFG)
European Research Council 2010 Starting Independent Investigator