Predicting malignant pleural effusion during diagnostic pleuroscopy with biopsy: A prospective multicentre study

Area of Science:

• Pulmonology
• Oncology
• Medical Diagnostics

Background:

• Pleuroscopy with pleural biopsy is highly sensitive for malignant pleural effusion (MPE).
• MPE recurrence necessitates concurrent diagnosis and treatment during pleuroscopy.
• Accurate on-site diagnosis is crucial for immediate treatment decisions.

Purpose of the Study:

• To develop a predictive model for estimating MPE probability during pleuroscopy.
• To enhance diagnostic confidence for same-day MPE treatment.
• To improve patient management by integrating diagnostic and therapeutic procedures.

Main Methods:

• Prospective observational multicentre cohort study.
• Logistic regression model incorporating visual assessment, rapid on-site evaluation (ROSE) of touch preparation, and CT findings.
• Bootstrapped training/testing for cross-validated area under the receiver operating characteristic curve (AUC) estimation.

Main Results:

• Visual assessment (OR=34.68), ROSE (OR=11.63), and CT nodules/masses (OR=6.61) were significantly associated with MPE.
• A multivariable model combining these factors achieved a cross-validated AUC of 0.94 (95% CI: 0.91-0.97).
• The model demonstrated excellent predictive accuracy for MPE.

Conclusions:

• A predictive model integrating visual assessment, ROSE, and CT findings accurately predicts MPE.
• This model supports confident on-site diagnosis for concurrent MPE treatment.
• Further validation studies are recommended to confirm these findings.