Cytopathology of pleural effusions after radiotherapy

The cytomorphology of pleural effusions following ionizing radiotherapy (IRT) has not been studied systematically. To determine if IRT produces alterations in pleural fluids that affect the cytopathologic interpretation of these specimens, two reviewers, without clinical information, independently assessed 55 specimens obtained following IRT and 39 control specimens obtained from nonirradiated cancer patients. None of the 24 cytologic features studied were identified significantly more frequently by both reviewers in the irradiated specimens. Only one feature (bizarre cells) was found to occur significantly more frequently in the irradiated specimens (36% versus 15%, P = .03) by either reviewer (reviewer B). Four other features showed a tendency to occur more frequently in the irradiated fluids by one or the other reviewer. They included degenerative changes (27% versus 13%, P = .09 [reviewer A]), smudgy chromatin (16% versus 5%, P = .09 [reviewer A]), large cytoplasmic vacuoles deforming the nuclei (44% versus 26%, P = .07 [reviewer B]) and cytomegaly (38% versus 23%, P = .12 [reviewer B]). The utility of these five features in identifying irradiated specimens was rigorously retested in a second masked review conducted jointly by the two pathologists. None of these features was found more frequently in the irradiated specimens in the second analysis. The results suggest that IRT does not consistently produce distinctive cytologic changes in pleural effusions and that a history of IRT should not affect the interpretation of these specimens.