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Differentiating Malignant from Tubercular Pleural Effusion by Cancer Ratio Plus (Cancer Ratio: Pleural Lymphocyte
Akash Verma1, Rucha S Dagaonkar1, Dominic Marshall2
1Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433.
Canadian Respiratory Journal
|January 11, 2017
Summary
The cancer ratio effectively identifies malignant pleural effusion (MPE). Combining it with pleural lymphocyte count, termed "cancer ratio plus," significantly improves diagnostic specificity for MPE without extra costs.
Area of Science:
- Pulmonology
- Oncology
- Diagnostic Medicine
Background:
- Malignant pleural effusion (MPE) diagnosis can be challenging.
- Previous retrospective studies suggested the cancer ratio (serum LDH: pleural ADA) predicts MPE.
- Prospective validation of the cancer ratio and its combination with pleural lymphocyte count was needed.
Purpose of the Study:
- To prospectively validate the cancer ratio for diagnosing MPE.
- To assess the diagnostic performance of "cancer ratio plus" (cancer ratio combined with pleural lymphocyte count).
- To evaluate the cost-effectiveness and efficiency of these diagnostic markers.
Main Methods:
- Prospective cohort study including 118 patients with lymphocyte-predominant exudative pleural effusion.
- Calculation of cancer ratio (serum LDH: pleural ADA) and "cancer ratio plus" (cancer ratio and pleural fluid lymphocyte count).
- Multivariate logistic regression analysis to identify predictors of MPE.
Main Results:
- 84 patients (71.2%) had MPE and 34 (28.8%) had tuberculous pleural effusion (TPE).
- Cancer ratio, serum LDH: pleural fluid lymphocyte count ratio, and "cancer ratio plus" correlated positively with MPE.
- "Cancer ratio plus" demonstrated high sensitivity (97.6%) and specificity (94.1%) for MPE diagnosis.
Conclusions:
- The cancer ratio is a valuable tool for identifying MPE.
- "Cancer ratio plus" significantly enhances the specificity of MPE diagnosis.
- These methods offer improved diagnostic accuracy for MPE without additional cost or resources.
