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Predicting Malignancy in Transudative Pleural Effusions
Celal Satici1, Furkan Atasever1, Banu Kahriman1
1Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, 34020 Istanbul, Turkey.
Journal of Clinical Medicine
|July 28, 2026
Summary
Malignant pleural effusions (MPE) can be missed in transudative effusions. Key predictors include thoracic CT findings, high LDH, and low glucose, aiding diagnosis with a new prediction score.
Area of Science:
- Pulmonology
- Oncology
- Diagnostic Medicine
Background:
- Transudative pleural effusions are typically benign, but a subset can indicate malignant pleural effusions (MPE).
- Underdiagnosis of MPE occurs due to infrequent pleural fluid cytology in transudative effusions.
- Identifying malignancy predictors in transudative effusions is crucial for timely diagnosis.
Purpose of the Study:
- To identify predictors of malignancy in transudative pleural effusions.
- To develop and validate a clinical prediction score for MPE in this patient group.
Main Methods:
- Retrospective cohort study of 314 patients with transudative pleural effusions undergoing cytological analysis.
- Analysis of clinical, radiological, laboratory, and pleural fluid characteristics.
- Multivariable logistic regression and bootstrap resampling for predictor identification and score validation.
Main Results:
- Malignant pleural effusions (MPE) were diagnosed in 7.6% of patients.
- Independent predictors of MPE included pleural pathology on thoracic CT, parenchymal nodule/mass, pleural fluid LDH > 150 U/L, and pleural fluid glucose < 100 mg/dL.
- A 16-point scoring system demonstrated excellent discriminative performance (AUC 0.89).
Conclusions:
- Pleural pathology on thoracic CT, parenchymal nodule/mass, elevated pleural fluid LDH, and low pleural fluid glucose predict MPE in transudative effusions.
- A simple 16-point prediction score effectively identifies patients needing further cytological evaluation.
- This score can improve the detection of malignancy in patients with initially classified transudative effusions.
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01:25Pleural Effusion I: Introduction
Pleural effusion is an abnormal fluid accumulation in the pleural cavity, a narrow space between the lungs and the chest wall. It is not a disease per se but rather a symptom or indication of an underlying disease. In normal circumstances, this space contains a small amount of fluid (5 to 15 mL), a lubricant facilitating the non-frictional movement of the pleural surfaces.
There are two main types of pleural effusion: transudative and exudative. They are differentiated using Light's criteria,...
There are two main types of pleural effusion: transudative and exudative. They are differentiated using Light's criteria,...
01:28Pleural Effusion II: Symptoms and Management
Pleural Effusion Overview
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations: