Elsevier

Clinical Radiology

Volume 56, Issue 3, March 2001, Pages 193-196
Clinical Radiology

Regular Article
Thoracic Computed Tomography in Patients with Suspected Malignant Pleural Effusions

https://doi.org/10.1053/crad.2000.0573Get rights and content

Abstract

AIM: To assess the role of contrast-enhanced computed tomography (CT) prospectively in patients with suspected malignant pleural effusions.

MATERIALS AND METHODS: Forty consecutive patients referred for the investigation of a suspected malignant pleural effusion had contrast-enhanced thoracic CT, thoracoscopy, thoraco-centesis and pleural biopsy, either percutaneously or at thoracoscopy. Final diagnoses were based on histopathological or cytological analysis (n = 30), autopsy findings (n = 3) or clinical follow-up (n = 7). The pleural surfaces were classified at contrast-enhanced CT as normal or abnormal and, if abnormal, as benign or malignant in appearance using previously established CT criteria for malignant pleural thickening by two observers unaware of the pathological diagnosis.

RESULTS: Pleural effusions were malignant in 32 patients and benign in eight patients. Pleural surfaces assessed at CT showed features of malignancy in 27 out of 32 patients with a malignant effusion (sensitivity 84%, specificity 100%). Overall, CT appearances indicated the presence of malignancy in 28 of 32 (87%) patients. All eight patients with benign pleural disease were correctly diagnosed by CT.

CONCLUSION: Contrast-enhanced CT is of value in patients with suspected malignant pleural effusions. The previously established criteria for malignant pleural thickening of nodularity, irregularity and pleural thickness >1 cm are reliable in the presence of a pleural effusion. Traill, Z. C.et al. (2001). Clinical Radiology, 56, 193–196.

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    Citation Excerpt :

    These 4 features are said to have high specificities (87%–100%, 68%–97%, 64%–98%, and 63%–100%) but low sensitivities (18%–53%, 14%–74%, 7%–47% and 7%–54%, respectively).33–39 The presence of circumferential pleural thickening in the presence of pleural fluid is less specific for malignancy.36 The positive predictive value of a malignant CT report is 80% but the negative predictive value (to exclude malignancy) is only 65%.40

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Author for correspondence and guarantor of study: Dr Z.C. Traill, Department of Radiology, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ. Fax: 01865 225946

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