Diagnostic pitfalls of discriminating lymphoma-associated effusions.
High serum lactate dehydrogenase (LDH) level, immunologic defects, enlarged mediastinal lymph nodes, and frequent hydration and diuresis in lymphoma patients may affect the development of pleural effusion (PE). The study was to assess the clinical utility of "Light criteria" and the "recommended algorithm for investigating PEs" in patients with lymphoma.The characteristics of 126 PEs of lymphoma patients who underwent diagnostic thoracentesis between January 1, 2003, and April 30, 2012, were reviewed. Using Light criteria, 29 (23%) PEs were incorrectly classified. The sensitivity for exudates in Light criteria was 88% and the specificity was only 44%. In 32 transudates, PE LDH correlated with blood LDH concentration (P < 0.001, r = 0.66). Nine transudates were misclassified as exudates (50%; 9/18) just due to PE LDH more than two-thirds the upper limits. Among the 56 bilateral PEs, 33 (59%) were exudates. Ten (63%) polymorphonuclear (PMN)-predominant exudative PEs were malignant. Infective PEs were often mononuclear (67%) rather than PMN predominant.When a patient has lymphoma with either unilateral or bilateral PE, thoracentesis for microbiological testing and cytology is imperative. Carefully clinical correlation in addition to the result from Light criteria and differential cell count is essential for prompt management.
From the Division of Pulmonary and Critical Care Medicine (H-JC, K-YH, S-JL, C-YT); Department of Internal Medicine (H-JC, K-YH, L-YB, S-JL, C-YT); Department of Pathology (G-CT); Division of Hematology and Oncology (L-YB), China Medical University Hospital; Department of Respiratory Therapy (H-JC, S-JL), China Medical University; Department of Internal Medicine (L-HC), Buddhist Tzu-Chi General Hospital, Taichung, Taiwan; and Division of Allergy, Pulmonary and Critical Care Medicine (RWL), Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Hung-Jen
HJ
Chen
Kuo-Yang
KY
Huang
Guan-Chin
GC
Tseng
Li-Hsiou
LH
Chen
Li-Yuan
LY
Bai
Shinn-Jye
SJ
Liang
Chih-Yen
CY
Tu
Richard W
RW
Light
D000465:Algorithms; D002452:Cell Count; D003937:Diagnosis, Differential; D005122:Exudates and Transudates / Q000737:chemistry*; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D008223:Lymphoma / Q000150:complications*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D010996:Pleural Effusion / Q000175:diagnosis* / Q000201:enzymology / Q000209:etiology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013624:Taiwan
D007770:L-Lactate Dehydrogenase