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Diagnostic Pitfalls of Discriminating Lymphoma-Associated Effusions

High serum lactate dehydrogenase (LDH) level, immunologic defects, enlarged mediastinal lymph nodes, and frequent hydration and diuresis in lymphoma patients may affect the development of pleural effusion (PE). The study was to assess the clinical utility of “Light criteria” and the “recommended alg...

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Autores principales: Chen, Hung-Jen, Huang, Kuo-Yang, Tseng, Guan-Chin, Chen, Li-Hsiou, Bai, Li-Yuan, Liang, Shinn-Jye, Tu, Chih-Yen, Light, Richard W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603050/
https://www.ncbi.nlm.nih.gov/pubmed/25929933
http://dx.doi.org/10.1097/MD.0000000000000800
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author Chen, Hung-Jen
Huang, Kuo-Yang
Tseng, Guan-Chin
Chen, Li-Hsiou
Bai, Li-Yuan
Liang, Shinn-Jye
Tu, Chih-Yen
Light, Richard W.
author_facet Chen, Hung-Jen
Huang, Kuo-Yang
Tseng, Guan-Chin
Chen, Li-Hsiou
Bai, Li-Yuan
Liang, Shinn-Jye
Tu, Chih-Yen
Light, Richard W.
author_sort Chen, Hung-Jen
collection PubMed
description High serum lactate dehydrogenase (LDH) level, immunologic defects, enlarged mediastinal lymph nodes, and frequent hydration and diuresis in lymphoma patients may affect the development of pleural effusion (PE). The study was to assess the clinical utility of “Light criteria” and the “recommended algorithm for investigating PEs” in patients with lymphoma. The characteristics of 126 PEs of lymphoma patients who underwent diagnostic thoracentesis between January 1, 2003, and April 30, 2012, were reviewed. Using Light criteria, 29 (23%) PEs were incorrectly classified. The sensitivity for exudates in Light criteria was 88% and the specificity was only 44%. In 32 transudates, PE LDH correlated with blood LDH concentration (P < 0.001, r = 0.66). Nine transudates were misclassified as exudates (50%; 9/18) just due to PE LDH more than two-thirds the upper limits. Among the 56 bilateral PEs, 33 (59%) were exudates. Ten (63%) polymorphonuclear (PMN)-predominant exudative PEs were malignant. Infective PEs were often mononuclear (67%) rather than PMN predominant. When a patient has lymphoma with either unilateral or bilateral PE, thoracentesis for microbiological testing and cytology is imperative. Carefully clinical correlation in addition to the result from Light criteria and differential cell count is essential for prompt management.
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spelling pubmed-46030502015-10-27 Diagnostic Pitfalls of Discriminating Lymphoma-Associated Effusions Chen, Hung-Jen Huang, Kuo-Yang Tseng, Guan-Chin Chen, Li-Hsiou Bai, Li-Yuan Liang, Shinn-Jye Tu, Chih-Yen Light, Richard W. Medicine (Baltimore) 4800 High serum lactate dehydrogenase (LDH) level, immunologic defects, enlarged mediastinal lymph nodes, and frequent hydration and diuresis in lymphoma patients may affect the development of pleural effusion (PE). The study was to assess the clinical utility of “Light criteria” and the “recommended algorithm for investigating PEs” in patients with lymphoma. The characteristics of 126 PEs of lymphoma patients who underwent diagnostic thoracentesis between January 1, 2003, and April 30, 2012, were reviewed. Using Light criteria, 29 (23%) PEs were incorrectly classified. The sensitivity for exudates in Light criteria was 88% and the specificity was only 44%. In 32 transudates, PE LDH correlated with blood LDH concentration (P < 0.001, r = 0.66). Nine transudates were misclassified as exudates (50%; 9/18) just due to PE LDH more than two-thirds the upper limits. Among the 56 bilateral PEs, 33 (59%) were exudates. Ten (63%) polymorphonuclear (PMN)-predominant exudative PEs were malignant. Infective PEs were often mononuclear (67%) rather than PMN predominant. When a patient has lymphoma with either unilateral or bilateral PE, thoracentesis for microbiological testing and cytology is imperative. Carefully clinical correlation in addition to the result from Light criteria and differential cell count is essential for prompt management. Wolters Kluwer Health 2015-05-01 /pmc/articles/PMC4603050/ /pubmed/25929933 http://dx.doi.org/10.1097/MD.0000000000000800 Text en Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 4800
Chen, Hung-Jen
Huang, Kuo-Yang
Tseng, Guan-Chin
Chen, Li-Hsiou
Bai, Li-Yuan
Liang, Shinn-Jye
Tu, Chih-Yen
Light, Richard W.
Diagnostic Pitfalls of Discriminating Lymphoma-Associated Effusions
title Diagnostic Pitfalls of Discriminating Lymphoma-Associated Effusions
title_full Diagnostic Pitfalls of Discriminating Lymphoma-Associated Effusions
title_fullStr Diagnostic Pitfalls of Discriminating Lymphoma-Associated Effusions
title_full_unstemmed Diagnostic Pitfalls of Discriminating Lymphoma-Associated Effusions
title_short Diagnostic Pitfalls of Discriminating Lymphoma-Associated Effusions
title_sort diagnostic pitfalls of discriminating lymphoma-associated effusions
topic 4800
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603050/
https://www.ncbi.nlm.nih.gov/pubmed/25929933
http://dx.doi.org/10.1097/MD.0000000000000800
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