{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:18:56Z","timestamp":1792196336564,"version":"4.4.0"},"reference-count":34,"publisher":"European Respiratory Society (ERS)","issue":"5","content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2018,9,10]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>The vast majority of undiagnosed unilateral pleural effusions have fluid sent for cytological analysis. Despite widespread use, there is uncertainty about its sensitivity to diagnose malignant pleural effusions (MPEs). Our aim was to ascertain the utility of cytology using a large prospective cohort.<\/jats:p><jats:p>Consecutive patients presenting with an undiagnosed unilateral pleural effusion were recruited to this UK-based study. All had pleural fluid sent for cytological analysis. Cytological sensitivity was based on the final diagnosis at 12\u2005months, confirmed by two consultants.<\/jats:p><jats:p>Over 8\u2005years, 921 patients were recruited, of which 515 had a MPE. Overall sensitivity of fluid cytology to diagnose malignancy was 46% (95% CI 42\u201358%). There was variation in sensitivity depending on cancer primary, with mesothelioma (6%) and haematological malignancies (40%) being significantly lower than adenocarcinomas (79%). MPEs secondary to ovarian cancer had high pick-up rates (95%). In\u00a0asbestos-exposed males with exudative effusions, the risk of MPE was 60%, but cytological sensitivity was 11%.<\/jats:p><jats:p>This is the largest prospective study of pleural fluid cytology and informs discussions with patients about the likely requirement for investigations following thoracentesis. In patients presenting with a clinical suspicion of mesothelioma, cytological sensitivity is low, so more definitive investigations could be performed sooner.<\/jats:p>","DOI":"10.1183\/13993003.01254-2018","type":"journal-article","created":{"date-parts":[[2018,9,27]],"date-time":"2018-09-27T14:14:29Z","timestamp":1538057669000},"page":"1801254","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":170,"title":["Investigating unilateral pleural effusions: the role of cytology"],"prefix":"10.1183","volume":"52","author":[{"given":"David T.","family":"Arnold","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duneesha","family":"De Fonseka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siobhan","family":"Perry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Morley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John\u00a0E.","family":"Harvey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Medford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Brett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick A.","family":"Maskell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2018,9,27]]},"reference":[{"key":"2024102100372867000_52.5.1801254.1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2010.136978"},{"key":"2024102100372867000_52.5.1801254.2","unstructured":"Royal College of Pathologists. Key Performance Indicators in Pathology. Recommendations from the Royal College of Pathologists. https:\/\/rcpath.org\/profession\/clinical-effectiveness\/key-performance-indicators-kpi.html Date last updated: April 2013."},{"key":"2024102100372867000_52.5.1801254.3","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-2353"},{"key":"2024102100372867000_52.5.1801254.4","first-page":"173","article-title":"Rentabilidad del estudio citol\u00f3gico del l\u00edquido pleural en el derrame maligno. [Accuracy of pleural fluid cytology in malignant effusions]","volume":"25","author":"Bielsa","year":"2008","journal-title":"An Med Interna"},{"key":"2024102100372867000_52.5.1801254.5","first-page":"320","article-title":"Diagnostic efficacy of pleural biopsy as compared with that of pleural fluid examination","volume":"4","author":"Nance","year":"1991","journal-title":"Mod Pathol"},{"key":"2024102100372867000_52.5.1801254.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)60212-2"},{"key":"2024102100372867000_52.5.1801254.7","doi-asserted-by":"publisher","DOI":"10.1378\/chest.67.5.536"},{"key":"2024102100372867000_52.5.1801254.8","doi-asserted-by":"publisher","DOI":"10.1378\/chest.111.1.106"},{"key":"2024102100372867000_52.5.1801254.9","doi-asserted-by":"publisher","DOI":"10.1159\/000158545"},{"key":"2024102100372867000_52.5.1801254.10","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-77-4-507"},{"key":"2024102100372867000_52.5.1801254.11","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/dju124"},{"key":"2024102100372867000_52.5.1801254.12","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1159\/000481290","article-title":"A prospective study to evaluate a diagnostic algorithm for the use of fluid lymphocyte subset analysis in undiagnosed unilateral pleural effusions","volume":"95","author":"Dixon","year":"2018","journal-title":"Respiration"},{"key":"2024102100372867000_52.5.1801254.13","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.arbres.2013.11.007","article-title":"Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses","volume":"50","author":"Porcel","year":"2014","journal-title":"Arch Bronconeumol"},{"key":"2024102100372867000_52.5.1801254.14","first-page":"665","article-title":"The value of multiple fluid specimens in the cytological diagnosis of malignancy","volume":"7","author":"Garcia","year":"1994","journal-title":"Mod Pathol"},{"key":"2024102100372867000_52.5.1801254.15","doi-asserted-by":"crossref","first-page":"602","DOI":"10.4103\/0973-1482.106574","article-title":"Cytomorphological profile of neoplastic effusions: an audit of 10\u2005years with emphasis on uncommonly encountered malignancies","volume":"8","author":"Gupta","year":"2012","journal-title":"J Cancer Res Ther"},{"key":"2024102100372867000_52.5.1801254.16","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19850815)56:4<905::AID-CNCR2820560435>3.0.CO;2-U"},{"key":"2024102100372867000_52.5.1801254.17","doi-asserted-by":"publisher","DOI":"10.1002\/dc.2840030103"},{"key":"2024102100372867000_52.5.1801254.18","doi-asserted-by":"publisher","DOI":"10.1136\/thx.34.1.106"},{"key":"2024102100372867000_52.5.1801254.19","doi-asserted-by":"crossref","first-page":"3161","DOI":"10.21037\/jtd.2017.08.52","article-title":"A comparative study of conventional cytology and cell block method in the diagnosis of pleural effusion","volume":"9","author":"Assawasaksakul","year":"2017","journal-title":"J Thorac Dis"},{"key":"2024102100372867000_52.5.1801254.20","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-2002"},{"key":"2024102100372867000_52.5.1801254.21","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2303.2000.00247.x"},{"key":"2024102100372867000_52.5.1801254.22","doi-asserted-by":"publisher","DOI":"10.1097\/PAT.0b013e32835bc848"},{"key":"2024102100372867000_52.5.1801254.23","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-010-0964-9"},{"key":"2024102100372867000_52.5.1801254.24","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1111\/j.1440-1843.2012.02177.x","article-title":"Clinical implications of pleural effusions in ovarian cancer","volume":"17","author":"Porcel","year":"2012","journal-title":"Respirology"},{"key":"2024102100372867000_52.5.1801254.25","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0019-2016"},{"key":"2024102100372867000_52.5.1801254.26","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/JTO.0b013e31823e0667","article-title":"Pleural fluid cytological yield and visceral pleural invasion in patients with epithelioid malignant pleural mesothelioma","volume":"7","author":"Pinelli","year":"2012","journal-title":"J Thorac Oncol"},{"key":"2024102100372867000_52.5.1801254.27","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/139.3.663"},{"key":"2024102100372867000_52.5.1801254.28","doi-asserted-by":"publisher","DOI":"10.1378\/chest.95.2.320"},{"key":"2024102100372867000_52.5.1801254.29","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-108-3-345"},{"key":"2024102100372867000_52.5.1801254.30","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2014-205285"},{"key":"2024102100372867000_52.5.1801254.31","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1097\/PAI.0000000000000543","article-title":"Comparison of epidermal growth factor receptor gene mutations identified using pleural effusion and primary tumor tissue samples in non-small cell lung cancer","volume":"26","author":"Liu","year":"2017","journal-title":"Appl Immunohistochem Mol Morphol"},{"key":"2024102100372867000_52.5.1801254.32","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/cyt.12517","article-title":"A combined test using both cell sediment and supernatant cell-free DNA in pleural effusion shows increased sensitivity in detecting activating EGFR mutation in lung cancer patients","volume":"29","author":"Kawahara","year":"2018","journal-title":"Cytopathology"},{"key":"2024102100372867000_52.5.1801254.33","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1002\/dc.23607","article-title":"Metastatic breast carcinoma in pleural fluid: correlation of receptor and HER2 status with the primary carcinoma \u2013 a pilot study","volume":"44","author":"Francis","year":"2016","journal-title":"Diagn Cytopathol"},{"key":"2024102100372867000_52.5.1801254.34","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/dc.21389","article-title":"Reliability of Her2\/neu, estrogen receptor, and progesterone receptor testing by immunohistochemistry on cell block of FNA and serous effusions from patients with primary and metastatic breast carcinoma","volume":"39","author":"Shabaik","year":"2011","journal-title":"Diagn Cytopathol"}],"container-title":["European Respiratory Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/13993003.01254-2018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T07:00:02Z","timestamp":1740380402000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/13993003.01254-2018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,27]]},"references-count":34,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2018,11,8]]},"published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1183\/13993003.01254-2018"],"URL":"https:\/\/doi.org\/10.1183\/13993003.01254-2018","relation":{},"ISSN":["0903-1936","1399-3003"],"issn-type":[{"value":"0903-1936","type":"print"},{"value":"1399-3003","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,27]]}}}