The diagnostic implications of the pleural fluid cell differentiation
Krishan Bansal1, Wei Wei Ee1, Sonia Patole1
1Respiratory Department, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
Journal of Thoracic Disease
|November 13, 2025
Summary
Pleural fluid cell differentiation shows limited diagnostic value for undiagnosed pleural effusions. While it can suggest a diagnosis, its accuracy as a definitive test is low, requiring cautious clinical use.
Area of Science:
- Pulmonology
- Cytopathology
Background:
- Pleural fluid cell differentiation is a recommended initial investigation for undiagnosed unilateral pleural effusions.
- The diagnostic sensitivity and specificity of initial pleural fluid cell differentiation remain unclear.
- This study aimed to determine the diagnostic value of pleural fluid cell differentiation.
Purpose of the Study:
- To establish the diagnostic value of pleural fluid cell differentiation in investigating undiagnosed pleural effusions.
- To assess the sensitivity and specificity of different cell types in pleural fluid for diagnosing effusions.
Main Methods:
- A prospective study of 997 patients with undiagnosed unilateral pleural effusions was conducted.
- Patient diagnoses were confirmed by respiratory consultants after 12 months.
- Cell differentiation followed British Thoracic Society (BTS) guidelines.
Main Results:
- Malignant etiology was found in 53.4% of patients, non-malignant in 46.7%.
- Lymphocytic effusions showed 35.5% sensitivity and 65.0% specificity for malignancy.
- Neutrophilic effusions were predominantly infectious (80%) but 14% were malignant; eosinophilic effusions had 43% malignancy.
Conclusions:
- Pleural fluid cell differentiation has limited diagnostic accuracy for ruling in or out diagnoses.
- The test may offer guidance but should be used cautiously by clinicians.
- Further investigations are needed to enhance diagnostic accuracy for pleural effusions.
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