Abstract Background: Despite the fact that Light’s criteria remain the gold standard approach in
differentiating exudates from transudates, several fluid markers have been introduced for establishing
the cause of pleural effusion to differentiate types of pleural exudate.
Aim: The aim of this study was to explore means of discriminating between malignant and non
malignant pleural effusions.
Methods: The study conducted on 45 patients (28-males and 17 females) with pleural effusions of
different etiologies. They were classified according to their final diagnosis into four groups: Group I:
10 cases (6 males and 4 females) with tuberculous pleural effusions. Group II: 15 cases (8 males and
7 females) with malignant pleural effusions. Group III: 10 cases (7 males and 3 females) with parapneumonic
effusion. Group IV: 10 cases (7 males and 3 females) with transudative pleural effusions
included as a control group. The complete biochemical analysis of pleural fluid, pleural fluid
culture, and pathological examination of pleural fluid and tissue was performed. Moreover, quantitative
measurement of TNF-a in serum and pleural fluid using ELISA was performed.
Results: Levels of TNF-a were significantly higher in the pleural fluid of exudative nature
compared to transudative type. There was a significant increase in pleural fluid TNF-a level in
non malignant effusions (tuberculous and parapneumonic) compared with malignant effusion. Also
there was a significant increase in pleural fluid TNF-a level in tuberculous effusion versus malignant
effusion. These results indicate that TNF-a may be considered a sensitive marker in differentiation
between malignant and non malignant pleural effusions.
Conclusion: Pleural fluid level of TNF-a can be used in differentiating malignant from non
malignant effusion. Also levels of TNF-a in the serum and pleural fluid could be useful as a complementary
marker in the differential diagnosis of two most common types of exudates (tuberculous
and malignant). |
