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Analysis of pleural effusions using flow cytometry

B B Ceyhan1, E Demiralp, T Celikel

  • 1Department of Pulmonary Medicine, Marmara University, Istanbul, Turkey.

Respiration; International Review of Thoracic Diseases
|January 1, 1996
PubMed
Summary
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Flow cytometry aids in diagnosing malignant pleural effusions by detecting abnormal DNA content and increased G2+M phase cells. This method, particularly analyzing activated T cells, is recommended when cytology results are uncertain.

Area of Science:

  • Oncology
  • Immunology
  • Cell Biology

Background:

  • Pleural effusions are common clinical findings with diverse etiologies.
  • Accurate differentiation between malignant and benign pleural effusions is crucial for patient management.
  • Traditional diagnostic methods like cytology can sometimes yield equivocal results.

Purpose of the Study:

  • To evaluate the utility of flow cytometry in distinguishing malignant from benign pleural effusions.
  • To assess specific flow cytometric parameters, including DNA index, cell cycle distribution, immunophenotyping, and tumor markers.

Main Methods:

  • Flow cytometry was performed on pleural fluid samples from 26 patients (15 malignant, 9 benign).
  • Analysis included DNA content, cell cycle phase distribution (G1/G0, S, G2+M), mononuclear cell immunophenotyping (CD3, CD4, CD8, CD38), and carcinoembryonic antigen (CEA) levels.

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Main Results:

  • Malignant effusions showed a significantly increased DNA index (1.32 vs. 0.88, p < 0.04) and a higher proportion of G2+M phase cells (p < 0.03).
  • The lymphocyte activation marker CD38 was significantly higher in malignant effusions (57.6% vs. 38.5%, p < 0.04).
  • Elevated carcinoembryonic antigen (CEA) levels were observed in malignant effusions (98.7 ng/ml vs. 0.9 ng/ml, p < 0.03).

Conclusions:

  • Flow cytometry, by identifying abnormal DNA content and increased G2+M cells, strongly supports the diagnosis of malignant pleural effusions.
  • Analysis of mononuclear cell phenotypes, particularly activated T cells (CD38+), is valuable in diagnosing malignant pleural effusions.
  • Flow cytometry is recommended as an adjunct diagnostic tool when pleural fluid cytology is equivocal.