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PubMed citations

How many thoracenteses are needed to exclude malignancy?

1. BTS guidelines for the investigation of a unilateral pleural effusion in adults.

Maskell NA, Butland RJ, Pleural Diseases Group, Standards of Care Committee, British Thoracic Society.
Thorax 2003;58 Suppl 2:ii8-17. PMID: 12728146
Guideline, cited by PIER
"The results of the major series reporting the sensitivity of pleural cytology are shown in table 2. These sensitivities vary from 40% to 87%, with a mean of about 60%. Of 55 cases where malignancy was diagnosed on the basis of cytological examination, Garcia et al found 65% were established from the first specimen, a further 27% from the second, and only 5% from the third."
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2. Diagnosis of lung cancer: the guidelines.

Rivera MP, Detterbeck F, Mehta AC, American College of Chest Physicians.
Chest 2003;123:129S-136S. PMID: 12527572
Guideline, found by SUMSearch
"When three separate pleural fluid specimens from a patient with malignant pleural disease are submitted to an experienced cytologist, one should expect a positive diagnosis in about 80% of patients."
"after at least two thoracentesis procedures"
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3. Volume of pleural fluid required for diagnosis of pleural malignancy.

Sallach SM, Sallach JA, Vasquez E, Schultz L, Kvale P.
Chest 2002;122:1913-7. PMID: 12475826
Journal Article, found by SUMSearch
"Volume does not matter."
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4. Clinical practice. Pleural effusion.

Light RW.
N Engl J Med 2002;346:1971-7. PMID: 12075059
Case Reports, cited by PIER
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5. Management of malignant pleural effusions.

American Thoracic Society.
Am J Respir Crit Care Med 2000;162:1987-2001. PMID: 11069845
Guideline.
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6. Diagnostic accuracy of effusion cytology.

Motherby H, Nadjari B, Friegel P, Kohaus J, Ramp U, Böcking A.
Diagn Cytopathol 1999;20:350-7. PMID: 10352907
Journal Article.
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7. Thoracoscopy--state of the art.

Loddenkemper R.
Eur Respir J 1998;11:213-21. PMID: 9543295
Journal Article.
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8. The value of multiple fluid specimens in the cytological diagnosis of malignancy.

Garcia LW, Ducatman BS, Wang HH.
Mod Pathol 1994;7:665-8. PMID: 7991525
Journal Article, cited by British Thoracic Society
"Overall, a cytological diagnosis of malignancy was made on at least one specimen for 55 patients (26%). The first positive diagnosis was made on the initial specimen in 36 patients (65%), on the second in 15 patients (27%), the third in three patients (5%), and the fifth in one patient (2%)"
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9. The malignant pleural effusion. A review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients.

Johnston WW.
Cancer 1985;56:905-9. PMID: 4016683
Journal Article, cited by PIER
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10. The cytologic diagnosis of malignant neoplasms in pleural and peritoneal effusions.

Sears D, Hajdu SI.
Acta Cytol ;31:85-97. PMID: 3469856
Journal Article, cited by PIER
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