The role of cytological evaluation of pleural fluid in diagnosing malignant mesothelioma.

Malignant mesothelioma is the most significant pleural tumour and it can be divided into three types: epithelial, sarcomatoid and biphasic mesothelioma. The most significant clinical manifestation of this tumour is pleural effusion. This paper was aimed at determining the role of cytological evaluation of pleural fluid in the diagnosis of malignant mesothelioma. This retrospective study included 33 medical records of patients with pleural malignant mesothelioma referred to the Institute for Lung Diseases of Vojvodina, in Sremska Kamenica in the period from 2004 to 2009. In 24 out of 33 patients, x-rays confirmed pleural effusion, thoracentesis was performed and specimens of effusion were cytologically examined at the Department of Pathology of the Institute for Lung Diseases of Vojvodina. Forty-nine cytological examinations were done. Only 2 of the first specimens were positive for malignant cells and 6 were suspicious. In repeated cytological examinations, 5 out of 6 initially suspicious specimens were positive for malignant cells, and the remaining 1 was negative. To sum up, 7 of 49 cytological examinations were positive and the sensitivity of our cytological study for the diagnosis of malignancy was 29%. Due to the low sensitivity of the cytological examinations, it has been recommended to perform biopsy of the pleura for definitive diagnosis in every patient with clinical symptoms and suspicious radiography.