Skip to main content
  • Original article
  • Open access
  • Published:

Validation of a simple computed tomography scoring system to predict the malignant nature of pleural effusion

Abstract

Objective

Weaimed to validate a computed tomography (CT) scoring system and assess its sensitivity and specificity to predict the malignant nature of pleural effusion that is exudative and of undetermined origin.

Patients and methods

This is a retrospective study that enrolled 123 patients who were referred for medical thoracoscopy in the Chest Department, Alexandria Main University Hospital, between 2013 and 2017 for diagnosing exudative pleural effusion of undetermined origin. CT scans were reviewed by a radiologist who was blinded to the final diagnosis. We applied a scoring system that was generated by Porcel et al. Scoring results were then evaluated using the final diagnosis of thoracoscopic pleural biopsies as the reference.

Results

The CT score showed a sensitivity and a specificity of 70 and 66.7%, respectively, with an negative predictive value 83% and a positive predictive value 48%, and the area under the receiver operating characteristic curve was 0.745.using a cut-off value of at least 7.

Conclusion

The CT scoring system could not predict the malignant nature of exudative effusion with great accuracy.

References

  1. Porcel JM, Esquerda A, Vives M, Bielsa S. Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses. Arch Bronconeumol 2014; 50:161–165.

    Article  Google Scholar 

  2. Gunnels J. Perplexing pleural effusions. Chest 1978; 74:390–393.

    CAS  PubMed  Google Scholar 

  3. Rubins JB, Colice GL. Evaluating pleural effusions. Postgrad Med J 1999; 105:39–48.

    Article  CAS  Google Scholar 

  4. Hooper C, Lee YC, Maskell N. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax 2010; 65:ii4–ii17.

    Article  Google Scholar 

  5. Clive AO, Kahan BC, Hooper CE, Bhatnagar R, Morley AJ, Zahan Evan N, et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax 2014; 69:1098–1104.

    Article  Google Scholar 

  6. Traill ZC, Davies RJ, Gleeson FV. Thoracic computed tomography in patients with suspected malignant pleural effusions. Clin Radiol 2001; 56:193–196.

    Article  CAS  Google Scholar 

  7. Hallifax RJ, Haris M, Corcoran JP, Leyakathalikhan S, Brown E, Srikantharaja D, et al. Role of CT in assessing pleural malignancy prior to thoracoscopy. Thorax 2015; 70:192–193.

    Article  CAS  Google Scholar 

  8. Porcel JM, Pardina M, Bielsa S, González A, Light RW. Derivation and validation of a CT scan scoring system for discriminating malignant from benign pleural effusions. Chest 2015; 147:513–519.

    Article  Google Scholar 

  9. Marel M, Zrustova M, Stasny B, Light RW. The incidence of pleural effusion in a well-defined region. Epidemiologic study in central Bohemia. Chest 1993; 104:1486–1489.

    Article  CAS  Google Scholar 

  10. Leung AN, Müller NL, Miller RR. CT in differential diagnosis of diffuse pleural disease. Am J Roentgenol 1990; 154:487–492.

    Article  CAS  Google Scholar 

  11. Scott EM, Marshall TJ, Flower CD, Stewart S. Diffuse pleural thickening: percutaneous CT-guided cutting needle biopsy. Radiology 1995; 194:867–870.

    Article  CAS  Google Scholar 

  12. Davies HE, Nicholson JE, Rahman NM, Wilkinson EM, Davies RJ, Lee YC. Outcome of patients with nonspecific pleuritis/fibrosis on thoracoscopic pleural biopsies. Eur J Cardiothorac Surg 2010; 38:472–477.

    Article  Google Scholar 

  13. Arenas-Jiménez JJ, García-Garrigós E, Escudero-Fresneda C, Sirera-Matilla M, García-Pastor I, et al. Early and delayed phases of contrast-enhanced CT for evaluating patients with malignant pleural effusion. Results of pairwise comparison by multiple observers. Br J Radiol 2018; 91:20180254.

    Article  Google Scholar 

  14. Yang MF, Tong ZH, Wang Z, Yang MF, Tong ZH, Wang Z, et al. Development and validation of the PET-CT score for diagnosis of malignant pleural effusion. Eur J Nucl Med Mol Imaging 2019; 46:1457–1467.

    Article  Google Scholar 

  15. Porcel JM, Hernandez P, Martinez-Alonso M, Bielsa S, Salud A. Accuracy of fluorodeoxyglucose-PET imaging for differentiating benign from malignant pleural effusions: a meta-analysis. Chest 2015; 147:502–512.

    Article  Google Scholar 

  16. Porcel JM, Parinda M, Aleman C, Pallisa E, Light RW, Bielsa S. Computed tomography scoring system for discriminating between parapneumonic effusions eventually drained and those cured only with antibiotics. Respirology 2017; 22:1199–1204.

    Article  Google Scholar 

  17. Tsim S, Stobo DB, Alexander L, Kelly C, Blyth KG. The diagnostic performance of routinely acquired and reported computed tomography imaging in patients presenting with suspected pleural malignancy. Lung Cancer 2017; 103:38–43.

    Article  Google Scholar 

  18. Safwat T, Sharkawy S, Shoukri A, Mohamed S. Correlation between computed tomography of the chest and medical thoracoscopic findings in primary pleural tumors. Egypt J Bronchol 2014; 8:32–37.

    Article  Google Scholar 

  19. Walker S, Maskell N. Identification and management of pleural effusions of multiple aetiologies. Curr Opin Pulm Med 2017; 23:339–345.

    Article  Google Scholar 

  20. Gonlugur TE, Gonlugur U. Transudates in malignancy: still a role for pleural fluid. Ann Acad Med Singapore 2008; 37:760–763.

    PubMed  Google Scholar 

  21. Bintcliffe OJ, Hooper CE, Rider IJ, Finn RS, Morley AJ, Zahan E, et al. Unilateral pleural effusions with more than one apparent etiology. A prospective observational study. Ann Am Thorac Soc 2016; 13:1050–1056.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ayman I. Baess MD, PhD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sweed, R.A., Baess, A.I. Validation of a simple computed tomography scoring system to predict the malignant nature of pleural effusion. Egypt J Bronchol 13, 710–715 (2019). https://doi.org/10.4103/ejb.ejb_46_19

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_46_19

Keywords