Behaviour of nucleated cells in various types of pleural effusion

L Ferreiro; T Pereiro; E San José; M E Toubes; J Suárez-Antelo; J M Álvarez Dobaño; F J González Barcala; N Rodríguez Núñez; A Lama; L Valdés

doi:10.1016/j.rce.2016.12.014

Behaviour of nucleated cells in various types of pleural effusion

Rev Clin Esp (Barc). 2017 Apr;217(3):136-143. doi: 10.1016/j.rce.2016.12.014. Epub 2017 Feb 16.

[Article in English, Spanish]

Authors

Affiliations

¹ Servicios de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España. Electronic address: lferfer7@gmail.com.
² Servicios de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España.
³ Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España; Servicio de Análisis Clínicos, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España.
⁴ Servicios de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España.

PMID: 28215651
DOI: 10.1016/j.rce.2016.12.014

Abstract

Introduction: To know the behavior of cellular components of pleural fluid can help focus the differential diagnosis of a pleural effusion. Our objective was to assess their composition in different types of pleural effusions and assess whether it provides relevant clinical information.

Patients and methods: Observational, cross-sectional and retrospective study in which the cellular components of pleural effusions of different etiology were analyzed. Pleural effusions were classified as neutrophilic, lymphocytic (≥50% of each one of them), eosinophilic (≥10%) or mesothelial (>5%) and were grouped into six diagnostic categories RESULTS: 1.467 patients were studied (354 heart failure; 59 other transudates; 349 paraneumonic; 133 tuberculous; 397 malignant and 175 other exudates). The predominance cell was lymphocytic in heart failure (44,4%), uncomplicated parapneumonic (29,2%), tuberculosis (88%) and malignant (49,6%); neutrophilic in parapneumonic (57%) and malignant (9,6%); eosinophilic in malignant (6,3%) and mesotelial in tuberculosis (12%). The most frequent etiologies with lymphocyte count ≥80% were tuberculosis (35,1%) and malignant (23,3%). Parameters with higher discriminating accuracy were: leukocytes (transudates: AUC 0,835) and percentage of neutrophils (empyemas: AUC 0,906 and complicated parapneumonic+empyemas: AUC 0,907).

Conclusions: Nucleated cell counts will help focus the etiology of pleural effusions, since each etiology often have a characteristic cell predominance. The percentage of nucleated cells in pleural fluid not ruled out tuberculosis if there is a high count of mesothelial cells, nor a parapneumonic effusion with lymphocytic predominance, or malignancy with ≥80% lymphocytes.

Keywords: Células mesoteliales; Células nucleadas totales; Derrame pleural; Derrame pleural eosinofílico; Derrame pleural linfocítico; Derrame pleural neutrofílico; Eosinophilic pleural effusion; Lymphocytic pleural effusion; Mesothelial cells; Neutrophilic pleural effusion; Percentage nucleated cells; Pleural effusion; Porcentaje células nucleadas; Total nucleated cells.