Utility of the combination of high fluorescence cells and tumor markers for the diagnosis of malignant pleural effusions

BACKGROUND

New diagnostic tools have emerged to assist the traditional diagnosis of malignant pleural effusion (MPE), such as high fluorescence cells (HFc) and tumor markers (TMs), determined by clinical laboratory automated pleural fluid workup. This study aimed to evaluate the diagnostic ability of the combination of HFc and TMs for diagnosing MPE.

METHODS

We recruited hospitalized patients with pleural effusion at Parc Taulí University Hospital. We collected and analyzed pleural fluid and serum samples in the clinical laboratory, and we sent a sample of pleural fluid to the Pathology Department for cytology workup. We determined the pleural fluid cell count by Sysmex XN-10 and assessed TMs (CEA, CA19.9, and CA15.3) using the ECLIA Cobas e801 Roche in both pleural fluid and serum samples. We established the final MPE diagnosis based on positive cytology and/or positive pleural biopsy. We classified patients based on these final diagnoses and conducted a comparison between variables, along with multivariate logistic regression.

RESULTS

The study included 316 pleural effusions from 221 patients recruited. Multivariate logistic regression indicated the most significant predictor variables for MPE were CA15.3 in serum, CEA ratio, and HFc. We calculated two different models: one excluding HFc and one including it, with the latter displaying superior diagnostic ability (area under the curve 0.91). This model could identify 100 % of MPE cases with 30 % specificity at low cut-offs, and higher values could help identify 60 % of MPE cases with 100 % specificity.

CONCLUSIONS

Per our findings, this model has high diagnostic performance and could serve as a swift, automated, dependable, non-invasive tool for MPE detection.

Temporal relationship between sarcoidosis and malignancies in a nationwide cohort of 1942 patients

PURPOSE

To investigate the phenotype of sarcoidosis according to the time when a malignancy is diagnosed (preexisting to the diagnosis of sarcoidosis, concomitant, or sequential) and to identify prognostic factors associated with malignancies in a large cohort of patients with sarcoidosis.

METHODS

We searched for malignancies in the SARCOGEAS cohort, a multicenter nationwide database of consecutive patients diagnosed with sarcoidosis according to the ATS/ESC/WASOG criteria. Solid malignancies were classified using the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) nomenclature, and hematological malignancies using the 2016 WHO classification. We excluded patients with a biopsy-proven diagnosis of sarcoidosis based exclusively on demonstrating granulomas in tissues also involved by malignant cells.

RESULTS

Out of 1942 patients with sarcoidosis, 233 (12%) developed 250 malignancies, including solid (n = 173), hematological (n = 57), and both types of malignancies (n = 3). Concerning the time interval between the diagnoses of both conditions, 83 (36%) patients were diagnosed with malignancy at least 1 year before sarcoidosis diagnosis, 22 (9%) had s synchronous diagnosis of both diseases, and 118 (51%) developed malignancies at least 1 year after the diagnosis of sarcoidosis (the remaining cases developed malignancies in different time intervals). The multivariate-adjusted model showed that individuals with sarcoidosis who developed a malignancy had an hazard ratio (HR) of 2.27 [95% confidence interval (CI), 1.62-3.17] for having an asymptomatic clinical phenotype at diagnosis of sarcoidosis and that spleen (presence vs. absence: HR = 2.06; 95% CI, 1.21-3.51) and bone marrow (presence vs. absence: HR = 3.04; 95% CI, 1.77-5.24) involvements were independent predictors for the development of all-type malignancies. No predictive factors were identified when the analysis was restricted to the development of solid malignancies. The analysis limited to the development of hematological malignancies confirmed the presence of involvement in the spleen (HR = 3.73; 95% CI, 1.38-10.06) and bone marrow (presence vs. absence: HR = 8.00; 95% CI, 3.15-20.35) at the time of sarcoidosis diagnosis as predictive factors.

CONCLUSION

It is essential to consider the synchronous or metachronous timing of the diagnosis of malignancies in people with sarcoidosis. We found that half of the malignancies were diagnosed after a diagnosis of sarcoidosis, with spleen and bone marrow involvement associated with a four to eight times higher risk of developing hematological malignancies. Key messages What is already known on this topic Malignancies are one of the comorbidities more frequently encountered in people with sarcoidosis What this study adds Malignancies occur in 12% of patients with sarcoidosis Malignancy may precede, coincide with, or follow the diagnosis of sarcoidosis One-third were identified before sarcoidosis, and half were diagnosed after Spleen and bone marrow involvement are risk factors for developing hematological malignancies How this study might affect research, practice or policy Patients with sarcoidosis should be regularly monitored for neoplasms, informed of the increased risk, and educated on early detection. Those with spleen or bone marrow involvement must be closely followed.