Kassirian Shayan, Hinton Stephanie N, Cuninghame Sean, Chaudhary Rushil, Iansavitchene Alla, Amjadi Kayvan, Dhaliwal Inderdeep, Zeman-Pocrnich Cady, Mitchell Michael A
Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Thorax. 2023 Jan;78(1):32-40. doi: 10.1136/thoraxjnl-2021-217959. Epub 2022 Feb 2.
Pleural fluid cytology is an important diagnostic test used for the investigation of pleural effusions. There is considerable variability in the reported sensitivity for the diagnosis of malignant pleural effusions (MPE) in the literature.
The purpose of this review is to determine the diagnostic sensitivity of pleural fluid cytology for MPE, both overall and by tumour type, to better inform the decision-making process when investigating pleural effusions.
A literature search of EMBASE and MEDLINE was performed by four reviewers. Articles satisfying inclusion criteria were evaluated for bias using the QUADAS-2 tool.
For quantitative analysis, we performed a metaanalysis using a binary random-effects model to determine pooled sensitivity. Subgroup analysis was performed based on primary cancer site and meta-regression by year of publication.
Thirty-six studies with 6057 patients with MPE were included in the meta-analysis. The overall diagnostic sensitivity of pleural fluid cytology for MPE was 58.2% (95% CI 52.5% to 63.9%; range 20.5%-86.0%). There was substantial heterogeneity present among studies (I 95.5%). For primary thoracic malignancies, sensitivity was highest in lung adenocarcinoma (83.6%; 95% CI 77.7% to 89.6%) and lowest in lung squamous cell carcinoma (24.2%; 95% CI 17.0% to 31.5%) and mesothelioma (28.9%; 95% CI 16.2% to 41.5%). For malignancies with extrathoracic origin, sensitivity was high for ovarian cancer (85.2%; 95% CI 74.2% to 96.1%) and modest for breast cancer (65.3%; 95% CI 49.8% to 80.8%).
Pleural fluid cytology has an overall sensitivity of 58.2% for the diagnosis of MPE. Clinicians should be aware of the high variability in diagnostic sensitivity by primary tumour type as well as the potential reasons for false-negative cytology results.PROSPERO registration numberCRD42021231473.
胸腔积液细胞学检查是用于胸腔积液调查的一项重要诊断测试。文献中报道的恶性胸腔积液（MPE）诊断敏感性存在很大差异。
本综述的目的是确定胸腔积液细胞学检查对MPE的诊断敏感性，包括总体敏感性以及按肿瘤类型分类的敏感性，以便在调查胸腔积液时更好地为决策过程提供信息。
四位评审员对EMBASE和MEDLINE进行了文献检索。使用QUADAS-2工具对符合纳入标准的文章进行偏倚评估。
为进行定量分析，我们使用二元随机效应模型进行荟萃分析以确定合并敏感性。基于原发癌部位进行亚组分析，并按发表年份进行meta回归分析。
荟萃分析纳入了36项研究，共6057例MPE患者。胸腔积液细胞学检查对MPE的总体诊断敏感性为58.2%（95%CI 52.5%至63.9%；范围20.5%-86.0%）。各研究之间存在显著异质性（I²=95.5%）。对于原发性胸部恶性肿瘤，肺腺癌的敏感性最高（83.6%；95%CI 77.7%至89.6%），肺鳞状细胞癌最低（24.2%；95%CI 17.0%至31.5%），间皮瘤为（28.9%；95%CI 16.2%至41.5%）。对于胸外起源的恶性肿瘤，卵巢癌的敏感性较高（85.2%；95%CI 74.2%至96.1%），乳腺癌中等（65.3%；95%CI 49.8%至80.8%）。
胸腔积液细胞学检查对MPE的总体诊断敏感性为58.2%。临床医生应意识到诊断敏感性因原发性肿瘤类型而异的高度变异性以及细胞学检查结果假阴性的潜在原因。
PROSPERO注册号：CRD42021231473
