Detection of Pleural Fluid Biochemistry Changes in Two Consecutive Thoracenteses for Differentiating Malignant From Benign Effusions

Abstract Objective To assess whether changes in pleural fluid (PF) biochemistries between two consecutive thoracenteses enable clinicians to predict malignant or benign pleural effusions (PE). Methods Retrospective study of patients with lymphocytic exudates and negative PF cytology, who underwent a second thoracentesis in our center in the last 15 years in whom a final diagnosis was reached (derivation sample). Absolute (Δ a ) and percentage differences (Δ p ) in PF biochemistries which predicted a malignant or benign PE in the derivation sample were evaluated in an independent population (validation sample). Results The derivation sample included 214 PE patients (70 malignant and 144 benign PE). Δ p lactate dehydrogenase (LDH)>0%, Δ p neutrophils>−10% (any increase or less than 10% decrease) and Δ a protein Conclusion An increase in LDH and neutrophils along with a decrease in protein in a second thoracentesis increase the probability of malignant PE, while the opposite reduces it significantly.