CLINICAL PROFILE OF MALIGNANT PLEURAL EFFUSIONS IN A TERTIARY CARE CENTRE

BACKGROUND Malignant pleural effusions are an important cause of exudative pleural effusions we see in clinical practice. The other main causes being syn-pneumonic and tuberculosis. The clinical features of the patient, and pleural fluid characteristics help us differentiate the cause in majority of cases. Malignant effusions are mostly lymphocytic and so the major differential is a tuberculous effusion, which is common in our setting. The former usually occurs as a far advanced disease, whereas the latter is often curable. Here comes the importance of identifying the aetiology of the effusion. The aim of this study was to determine the clinical features of the patient, and pleural fluid characteristics of malignant pleural effusion cases attending a tertiary care centre and to determine the mode of diagnosis in these cases. MATERIALS AND METHODS Setting and Design-This was a descriptive study done in the Department of Pulmonary Medicine, GMC, Trivandrum for six months from November 2017. All cases of pleural effusion attending the department during the period were evaluated to determine the aetiology and cases with malignant pleural effusions were included in the study. Methodology- A case was diagnosed as malignant if a cytological/histopathological evidence of malignancy was obtained from pleural fluid or any extrapleural site. If pleural fluid results were negative, a thoracoscopy and pleural biopsy was done. Even after these, if a positive pathology report was not obtained, they were still taken as malignancy if the radiological picture was very much suggestive. 50 consecutive cases of malignant pleural effusion were included in the study. The demographic details, smoking habits and pleural fluid characteristics were studied in all cases. Statistical Analysis was done using Epi Info 7. Quantitative variables were expressed as means +/- SD and categorical variables as proportion (95%, CI). RESULTS 62% of cases were males. Mean age was 62.08 (SD 13.83). 16% were current smokers. All were exudative effusions with a mean lymphocyte count of 81.12 (SD-19.38). Pleural fluid cytology was positive in 62% and the commonest histology was adenocarcinoma. CONCLUSION Malignant pleural effusions are mostly exudative lymphocytic effusions. Usual aetiology is adenocarcinoma and pleural fluid cytology is yielding in majority.