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Echographic septation: A potentially useful indicator discriminating tuberculous from malignant pleural effusion

Sze Shyang Kho¹, Swee Kim Chan¹, Siew Teck Tie¹

¹Division of Respiratory Medicine, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Sarawak, Malaysia.

Respiratory Investigation

|June 1, 2022

Abstract

Background:

Tuberculous (TBE) and malignant (MPE) pleural effusions present with similar lymphocytic exudates. As TBE is an inflammatory and hypersensitivity process, we hypothesized that echographic septation may be more prevalent in TBE than in MPE, potentially serving as a good clinical predictor for TBE.

Methods:

A total of 183 TBE and 266 MPE patients were recruited retrospectively. Multivariate logistic regression was performed to determine significant predictors for TBE.

Results:

TBE diagnosis was confirmed histologically (caseating granuloma) in 84.7% of the cases, while MPE was biopsy-proven in 63.9% of the cases. Echographic septation was more evident in TBE than in MPE (46.5% vs. 8.2%, p < 0.001). Multivariate logistic regression analysis showed that male sex, serum leucocyte count ≤9 × 10⁹/L or pleural fluid protein ≥50 g/L, and echographic septation (aOR: 9.28, p < 0.001) were independent predictors for TBE. These parameters collectively provided a diagnostic accuracy of 79.61% (95% CI 74.13-84.38).

Conclusions:

Echographic septation may potentially facilitate discrimination between TBE and MPE as part of a clinical prediction model. Prospective validation of this prediction model in an external cohort is anticipated.

Keywords:

Echographic septation.Transthoracic ultrasound.Tuberculosis Tuberculous pleural effusion

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