Ryu Jeong-Seon, Ryu Seong-Tae, Kim Young-Shin, Cho Jae-Hwa, Lee Hong-Lyeol
Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea.
Korean J Intern Med. 2003 Dec;18(4):230-3. doi: 10.3904/kjim.2003.18.4.230.
A few reports of transudative malignant effusion on a small number of patients have suggested the need to perform routine cytologic examination in all cases of transudative pleural effusion, whether encountered for malignancy or not. The purpose of this study was to investigate whether cytologic examination should be performed in all cases of transudative pleural effusion for the diagnosis of malignancy.
We performed a retrospective study of 229 consecutive patients with malignant pleural effusion, proven either cytologically or with biopsy. In patients with transudative pleural effusion, we reviewed medical records, results of transthoracic echocardiography, fiberoptic bronchoscopy, chest X-ray, chest CT scan, and ultrasonogram of the abdomen. These data were examined with particular attention to identifying whether or not the malignancy was suggested on chest X-ray, examining the involvement of the superior vena cava, great vessels, and lymph nodes, determining the presence of pericardial effusion, and observing the endobronchial obstruction.
Transudative malignant pleural effusion was observed in seven (3.1%) of the 229 patients, and was caused either by the malignancy itself (6 patients) or by coexisting cardiac diseases (1 patient). All the patients showed evidence suggesting the presence of malignancy at the time of initial thoracentesis, which facilitated the decision of most clinicians on whether to perform cytologic examination for the diagnosis of malignancy.
Therefore, in all cases of transudative pleaural effusion, no clinical implications indicating malignancy were found on cytologic examination.
少数关于少量患者漏出性恶性胸腔积液的报告表明，对于所有漏出性胸腔积液病例，无论是否因恶性肿瘤所致，都有必要进行常规细胞学检查。本研究的目的是调查是否应对所有漏出性胸腔积液病例进行细胞学检查以诊断恶性肿瘤。
我们对229例经细胞学或活检证实的恶性胸腔积液患者进行了一项回顾性研究。对于漏出性胸腔积液患者，我们查阅了病历、经胸超声心动图、纤维支气管镜检查、胸部X线、胸部CT扫描和腹部超声检查结果。特别关注这些数据，以确定胸部X线是否提示恶性肿瘤、检查上腔静脉、大血管和淋巴结的受累情况、确定心包积液的存在以及观察支气管内阻塞情况。
229例患者中有7例（3.1%）出现漏出性恶性胸腔积液，其原因要么是恶性肿瘤本身（6例），要么是并存的心脏疾病（1例）。所有患者在初次胸腔穿刺时均有提示恶性肿瘤存在的证据，这有助于大多数临床医生决定是否进行细胞学检查以诊断恶性肿瘤。
因此，在所有漏出性胸腔积液病例中，细胞学检查未发现提示恶性肿瘤的临床征象。
