title: The role of liquid-based cytology and ancillary techniques in pleural and pericardic effusions: an institutional experience.
abstract: BACKGROUND
  Fine-needle aspiration cytology (FNAC) of serous membrane effusions may fulfil a challenging role in the diagnostic analysis of both primary and metastatic disease. From this perspective, liquid-based cytology (LBC) represents a feasible and reliable method for empowering the performance of ancillary techniques (ie, immunocytochemistry and molecular testing) with high diagnostic accuracy.
  
  
  METHODS
  In total, 3171 LBC pleural and pericardic effusions were appraised between January 2000 and December 2013. They were classified as negative for malignancy (NM), suspicious for malignancy (SM), or positive for malignancy (PM).
  
  
  RESULTS
  The cytologic diagnoses included 2721 NM effusions (2505 pleural and 216 pericardic), 104 SM effusions (93 pleural and 11 pericardic), and 346 PM effusions (321 pleural and 25 pericardic). The malignant pleural series included 76 unknown malignancies (36 SM and 40 PM effusions), 174 metastatic lesions (85 SM and 89 PM effusions), 14 lymphomas (3 SM and 11 PM effusions), 16 mesotheliomas (5 SM and 11 SM effusions), and 3 myelomas (all SM effusions). The malignant pericardic category included 20 unknown malignancies (5 SM and 15 PM effusions), 15 metastatic lesions (1 SM and 14 PM effusions), and 1 lymphoma (1 PM effusion). There were 411 conclusive immunocytochemical analyses and 47 molecular analyses, and the authors documented 88% sensitivity, 100% specificity, 98% diagnostic accuracy, 98% negative predictive value, and 100% positive predictive value for FNAC.
  
  
  CONCLUSIONS
  FNAC represents a primary diagnostic tool for effusions and a reliable approach with which to determine the correct follow-up. Furthermore, LBC is useful for ancillary techniques, such as immunocytochemistry and molecular analysis, with feasible diagnostic and predictive utility.
authors: Division of Anatomic Pathology and Histology, "Agostino Gemelli" School of Medicine, Sacred Heart Catholic University, Rome, Italy.
authors: Esther Diana
authors: ED
authors: Rossi
authors: Tommaso
authors: T
authors: Bizzarro
authors: Fernando
authors: F
authors: Schmitt
authors: Adhemar
authors: A
authors: Longatto-Filho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003581:Cytodiagnosis / Q000379:methods*; D003584:Cytological Techniques; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D008297:Male; D008875:Middle Aged; D057089:Pathology, Molecular / Q000379:methods*; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000473:pathology; D010996:Pleural Effusion / Q000175:diagnosis* / Q000473:pathology; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000473:pathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: immunocytochemistry; liquid-based cytology; pericardic effusions; pleural effusions