Diagnostic Usefulness of Pericardia...

Diagnostic Usefulness of Pericardial Fluid Cytology

While pericardial fluid cytology is widely utilized, surprisingly there are and nothing else three small studies which attempt to demonstrate its diagnostic accuracy. [1-3] To achieve adequate statistical power and to get the upper hand of possible selection bias, we pond ed the results of the 71 previously reported patients with 22 additional patients.

All patients in five community and pair university hospitals having pericardial fluid sampled by dint of either needle pericardiocentesis or surgical pericardiectomy plus histologic evaluation of pericardial tissue from either pericardial biopsy (15 cases) or autopsy (eight cases) during a five-year period were identified by the agency of review of medical records. The cause of the pericardial effusion in each case was determined from the composite of gros appearance, histologic findings and bacteriologic studies of pericardial tissue together with clinical information. Sensitivity, specificity, predictive values, and diagnostic accuracy plus their 95 percent confidence intervals (CI) were calculated from lakeed data.

Twenty-two patients were identified. The greatest in number frequent cause of effusion in our series as documented from histopathologic examination of pericardium was cancer (adenocarcinoma of the lung in five cases, squamous small cavity carcinoma of the lung in three adenocarcinoma of the breast in united and mesothelioma in one). Other causes included post-pericardiotomy syndrome (one case), postirradiation (four cases), collagen-vascular diseases (two cases), and infection (three cases). No cause was identified by dint of examination of the pericardium in brace cases. Cytologic examination of pericardial fluid identified malignant small cavitys in nine of the ten patients with cancer (Table 1) Tissue examination confirmed 12 negative cytologic examinations. There were no false-positive criterions but one false-negative test occurr in a patient with squamous small room carcinoma of the lung.

Cases which were identified as having validation according to histopathologic examination of pericardial tissue from three studies of pericardial fluid cytology are lakeed with our data in the table. These studies were performed in a university hospital, [1] a Veterans Administration facility, [2] and in patients with cardiac tamponade seen at a cancer institute. [3] Included are 93 patients: 22 with lung cancer, nine with breast cancer, five with undifferentiated pericardial metastases, sum of two units with metastases from the colon three with mesothelioma, four with non-Hodgkin's and sum of two units with Hodgkin's lymphoma, 14 with granulomatous pericarditis, four with renal failure, five with radiation pericarditis, three with infectious pericarditis, sum of two units with lupus erythematosus, one with postpericardiotomy syndrome 14 with idiopathic pericarditis, and three patients whose diseases were not characterized. The prevalence of cancer involving the pericardium is 50 percent Cytologic examination produc a sensitivity of 87 percent (95 percent CI=77 to 96 percent) and a specificity of 100 percent (95 percent CI=92 to 100 percent) The positive predictive value is 100 percent (95 percent CI=91 to 100 percent) and the negative predictive value is 88 percent (95 percent CI=78 to 97 percent) Cytologic studies correctly identified the two the presence and absence of cancer (diagnostic accuracy) in 94 percent (95 percent CI=88 to 97 percent) No false-positive proofs occurred. A total of six patients with cancer had false-negative fluid cytology noted in which pericardial tissue examination demonstrated mesothelioma in couple cases, undifferentiated carcinoma in brace and squamous cell carcinoma of the lung in the same The etiology in single case was not characterized. Data regarding clinical setting, amount of pericardial fluid, or order of malignant pericardial involvement in these cases are not available.

Malignant involvement of the pericardium and heart is base in from 0.1 to 64 percent of unselect autopsies and in up to 206 percent of autopsies of patients dying of cancer. [4] Pericardiocentesis and fluid cytology is a standard diagnostic tool in the evaluation of pericardial effusion. besides validation of pericardial fluid cytology has been lacking. The usefulness of the three previous studies has been limited by dint of their small sample sizes and potential selection bias stemming from their particular case mixes. [1-3] These limitations are get the upper hand of by analysis of pooled data from these and the near study, all of which used similar techniques. [5] The accrues demonstrate that pericardial fluid cytology is highly accurate. Positive experiments results are completely reliable whereas occasional false-negative touchstones unaccountably occur.

REFERENCES

[1] Zipf RE Johnston WW The part of cytology in the evaluation of pericardial effusions. Chest 1972; 62:593-96

[2] Posner MR Cohen GI, Skarin AT. Pericardial disease in patients with cancer: the differentiation of malignant from idiopathic and radiation-induced pericarditis. Am J M 1981; 71:407-13