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Updated: Dec 18, 2025
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Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
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Suspicious for Malignancy Diagnoses on Pleural Effusion Cytology
Erika F Rodriguez1, Ricardo G Pastorello2,3, Paul Morris1
1Department of Pathology, Division of Cytopathology, Johns Hopkins Hospital, Baltimore, MD.
American Journal of Clinical Pathology
|June 12, 2020
Summary
Diagnosing suspicious for malignancy (SFM) pleural effusions is challenging. Larger sample volumes were associated with SFM diagnoses, but overall survival did not differ significantly compared to malignant pleural effusions.
Area of Science:
- Cytopathology
- Thoracic Oncology
- Diagnostic Pathology
Background:
- Malignant pleural effusions (MPE) pose diagnostic challenges.
- A definitive diagnosis of malignancy is not always possible in pleural effusions.
Purpose of the Study:
- To evaluate the diagnostic experience with pleural effusions classified as suspicious for malignancy (SFM).
- To identify factors associated with SFM diagnoses in pleural effusions.
Main Methods:
- Retrospective review of 90 patients with SFM pleural effusions (2008-2018).
- Specimens categorized by volume (<75, 75-400, >400 mL).
- Comparison with malignant pleural effusion (MPE) controls.
Main Results:
- SFM diagnoses included carcinoma/adenocarcinoma (64.4%), leukemia/lymphoma (15.6%), and others.
- Immunostains were inconclusive in 24% of cases.
- SFM group showed a higher proportion of larger volumes (>400 mL) compared to MPE (P=.001).
- No significant difference in mean overall survival between SFM and MPE groups (P=.49).
Conclusions:
- Low cellularity, scant cell blocks, and inconclusive immunostains contribute to SFM diagnoses.
- Sample volume may be a differentiating factor in SFM vs. MPE classification.
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