Lara et al used clinical, radiological, and pleural fluid findings to evaluate a pleural effusion. The authors are from La Fe University, University of Valencia, research centers and affiliated hospitals in Spain.
Patient selection: pleural effusion
Parameters:
(1) lung mass
(2) pleural thickening
(3) dyspnea
(4) history of cancer
(5) LDH in IU/L in pleural fluid
(6) pH in pleural fluid
Tree Diagram 1
Mass
Pleural Thickening
Dyspnea
History of Cancer
Endpoint
no
no
NA
NA
1
no
yes
NA
NA
2
yes
NA
no
NA
3
yes
NA
yes
no
4
yes
NA
yes
yes
5
Tree Diagram 2
Mass
LDH
Dyspnea
pH
Endpoint
no
<= 169
NA
NA
6
no
> 169
yes
NA
7
no
> 169
no
NA
8
yes
NA
NA
>= 7.38
9
yes
NA
NA
< 7.38
10
Endpoint
Malignant
Paramalignant
Benign
1
28.6%
5.7%
65.7%
2
77.8%
0%
22.2%
3
22.2%
77.8%
0%
4
78.6%
21.4%
0%
5
25%
75%
0%
6
8.3%
0%
91.7
7
65.2%
4.3%
30.4%
8
11.1%
11.1%
77.8%
9
26.7%
73.3%
0%
10
53.3%
16.7%
0%
where:
• It is interesting that a personal history of cancer in endpoint 5 is associated with a lower risk of cancer than its absence (endpoint 4).
The addition of cytology findings would be helpful in narrowing the diagnosis.
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