The prevalence of tumour markers in malignant pleural effusions associated with primary pulmonary adenocarcinoma: a retrospective study

Katrine Fjaellegaard; Jesper Koefod Petersen; Gitte Andersen; Matteo Biagini; Rahul Bhatnagar; Christian B Laursen; Paul Frost Clementsen; Uffe Bodtger

doi:10.1080/20018525.2021.1984375

The prevalence of tumour markers in malignant pleural effusions associated with primary pulmonary adenocarcinoma: a retrospective study

Eur Clin Respir J. 2021 Oct 31;8(1):1984375. doi: 10.1080/20018525.2021.1984375. eCollection 2021.

Authors

Katrine Fjaellegaard^{1

2}, Jesper Koefod Petersen^{1

2}, Gitte Andersen³, Matteo Biagini³, Rahul Bhatnagar^{4

5}, Christian B Laursen^{6

7}, Paul Frost Clementsen^{8

9

10}, Uffe Bodtger^{1

2

8}

Affiliations

¹ Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark.
² Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
³ Department of Pathology, Zealand University Hospital Roskilde, Roskilde, Denmark.
⁴ Department of Respiratory Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
⁵ Academic Respiratory Unit, University of Bristol, Bristol, UK.
⁶ Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.
⁷ Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
⁸ Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.
⁹ Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.
¹⁰ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

Abstract

Background: Oncological treatment of primary pulmonary adenocarcinoma (AC) includes drugs targeting the pathways involving programmed death-ligand 1 (PD-L1), epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK). The aim of the study was to report the prevalence of these tumour markers in pleural fluid with cytology positive for pulmonary AC and the potential influence of volume pleural fluid tested.

Methods: We retrospectively reviewed all thoracenteses performed in a two-year period at our interventional unit at Department of Respiratory Medicine at Zealand University Hospital Naestved, Denmark. ALK and PD-L1 testing was done using immunohistochemistry and EGFR testing using next-generation sequencing. We included pleural fluid specimens containing malignant cells originating from primary pulmonary AC and with at least one tumour marker requested by the clinicians.

Results: When screening 927 pleural fluid specimens, we identified 57 in accordance with the inclusion criteria. PD-L1, ALK and EGFR were obtained in 35/55 (64%), 38/57 (67%) and 26/47 (55%), respectively. The prevalence did not increase when analysing volumes > 50 mL (p = 0.21-0.58).

Conclusion: Tumour markers in pleural fluid specimens containing cells from pulmonary AC can be demonstrated in more than half of the cases. Therefore, supplementary invasive procedures than thoracentesis could potentially await these analyses.

Keywords: Lung cancer; anaplastic lymphoma kinase (ALK); epidermal growth factor receptor (EGFR) mutation; malignant pleural effusion; programmed death-ligand 1 (PD-L1); pulmonary adenocarcinoma; tumour markers.