Predicting malignant pleural effusion during diagnostic pleuroscopy with biopsy: A prospective multicentre study

Horiana B. Grosu; Ryan Kern; Fabien Maldonado; Roberto Casal; Clark R. Andersen; Liang Li; Georgie Eapen; David Ost; Carlos Jimenez; Frangiskos Frangopoulos; Bruce Sabath; Erik Vakil; Audra Schwalk; Mathieu Marcoux; Ala Eddin Sagar; Faria Nasim; Julie Lin; Moiz Salahudin; Hasan Muhammad Arain; Laila Noor; Diana Montanez; John Stewart; John Mullon; Michalis Michael; Ilias Porfyridis

doi:10.1111/resp.14232

Predicting malignant pleural effusion during diagnostic pleuroscopy with biopsy: A prospective multicentre study

Horiana B. Grosu, Ryan Kern, Fabien Maldonado, Roberto Casal, Clark R. Andersen, Liang Li, Georgie Eapen, David Ost, Carlos Jimenez, Frangiskos Frangopoulos, Bruce Sabath, Erik Vakil, Audra Schwalk, Mathieu Marcoux, Ala Eddin Sagar, Faria Nasim, Julie Lin, Moiz Salahudin, Hasan Muhammad Arain, Laila NoorDiana Montanez, John Stewart, John Mullon, Michalis Michael, Ilias Porfyridis

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Background and objective: Pleuroscopy with pleural biopsy has a high sensitivity for malignant pleural effusion (MPE). Because MPEs tend to recur, concurrent diagnosis and treatment of MPE during pleuroscopy is desired. However, proceeding directly to treatment at the time of pleuroscopy requires confidence in the on-site diagnosis. The study's primary objective was to create a predictive model to estimate the probability of MPE during pleuroscopy. Methods: A prospective observational multicentre cohort study of consecutive patients undergoing pleuroscopy was conducted. We used a logistic regression model to evaluate the probability of MPE with relation to visual assessment, rapid on-site evaluation (ROSE) of touch preparation and presence of pleural nodules/masses on computed tomography (CT). To assess the model's prediction accuracy, a bootstrapped training/testing approach was utilized to estimate the cross-validated area under the receiver operating characteristic curve. Results: Of the 201 patients included in the study, 103 had MPE. Logistic regression showed that higher level of malignancy on visual assessment is associated with higher odds of MPE (OR = 34.68, 95% CI = 9.17–131.14, p < 0.001). The logistic regression also showed that higher level of malignancy on ROSE of touch preparation is associated with higher odds of MPE (OR = 11.63, 95% CI = 3.85–35.16, p < 0.001). Presence of pleural nodules/masses on CT is associated with higher odds of MPE (OR = 6.61, 95% CI = 1.97–22.1, p = 0.002). A multivariable logistic regression model of final pathologic status with relation to visual assessment, ROSE of touch preparation and presence of pleural nodules/masses on CT had a cross-validated AUC of 0.94 (95% CI = 0.91–0.97). Conclusion: A prediction model using visual assessment, ROSE of touch preparation and CT scan findings demonstrated excellent predictive accuracy for MPE. Further validation studies are needed to confirm our findings.

Original language	English (US)
Pages (from-to)	350-356
Number of pages	7
Journal	Respirology
Volume	27
Issue number	5
DOIs	https://doi.org/10.1111/resp.14232
State	Published - May 2022
Externally published	Yes

Keywords

ROSE
malignant pleural effusion
pleurodesis
pleuroscopy
thoracoscopy
touch preparation

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine

Access to Document

10.1111/resp.14232

Cite this

Grosu, H. B., Kern, R., Maldonado, F., Casal, R., Andersen, C. R., Li, L., Eapen, G., Ost, D., Jimenez, C., Frangopoulos, F., Sabath, B., Vakil, E., Schwalk, A., Marcoux, M., Sagar, A. E., Nasim, F., Lin, J., Salahudin, M., Arain, H. M., ... Porfyridis, I. (2022). Predicting malignant pleural effusion during diagnostic pleuroscopy with biopsy: A prospective multicentre study. Respirology, 27(5), 350-356. https://doi.org/10.1111/resp.14232

Grosu, HB, Kern, R, Maldonado, F, Casal, R, Andersen, CR, Li, L, Eapen, G, Ost, D, Jimenez, C, Frangopoulos, F, Sabath, B, Vakil, E, Schwalk, A, Marcoux, M, Sagar, AE, Nasim, F, Lin, J, Salahudin, M, Arain, HM, Noor, L, Montanez, D, Stewart, J, Mullon, J, Michael, M & Porfyridis, I 2022, 'Predicting malignant pleural effusion during diagnostic pleuroscopy with biopsy: A prospective multicentre study', Respirology, vol. 27, no. 5, pp. 350-356. https://doi.org/10.1111/resp.14232

@article{8da344aced8f445e8c5af74f6632bd42,

title = "Predicting malignant pleural effusion during diagnostic pleuroscopy with biopsy: A prospective multicentre study",

abstract = "Background and objective: Pleuroscopy with pleural biopsy has a high sensitivity for malignant pleural effusion (MPE). Because MPEs tend to recur, concurrent diagnosis and treatment of MPE during pleuroscopy is desired. However, proceeding directly to treatment at the time of pleuroscopy requires confidence in the on-site diagnosis. The study's primary objective was to create a predictive model to estimate the probability of MPE during pleuroscopy. Methods: A prospective observational multicentre cohort study of consecutive patients undergoing pleuroscopy was conducted. We used a logistic regression model to evaluate the probability of MPE with relation to visual assessment, rapid on-site evaluation (ROSE) of touch preparation and presence of pleural nodules/masses on computed tomography (CT). To assess the model's prediction accuracy, a bootstrapped training/testing approach was utilized to estimate the cross-validated area under the receiver operating characteristic curve. Results: Of the 201 patients included in the study, 103 had MPE. Logistic regression showed that higher level of malignancy on visual assessment is associated with higher odds of MPE (OR = 34.68, 95% CI = 9.17–131.14, p < 0.001). The logistic regression also showed that higher level of malignancy on ROSE of touch preparation is associated with higher odds of MPE (OR = 11.63, 95% CI = 3.85–35.16, p < 0.001). Presence of pleural nodules/masses on CT is associated with higher odds of MPE (OR = 6.61, 95% CI = 1.97–22.1, p = 0.002). A multivariable logistic regression model of final pathologic status with relation to visual assessment, ROSE of touch preparation and presence of pleural nodules/masses on CT had a cross-validated AUC of 0.94 (95% CI = 0.91–0.97). Conclusion: A prediction model using visual assessment, ROSE of touch preparation and CT scan findings demonstrated excellent predictive accuracy for MPE. Further validation studies are needed to confirm our findings.",

keywords = "ROSE, malignant pleural effusion, pleurodesis, pleuroscopy, thoracoscopy, touch preparation",

author = "Grosu, {Horiana B.} and Ryan Kern and Fabien Maldonado and Roberto Casal and Andersen, {Clark R.} and Liang Li and Georgie Eapen and David Ost and Carlos Jimenez and Frangiskos Frangopoulos and Bruce Sabath and Erik Vakil and Audra Schwalk and Mathieu Marcoux and Sagar, {Ala Eddin} and Faria Nasim and Julie Lin and Moiz Salahudin and Arain, {Hasan Muhammad} and Laila Noor and Diana Montanez and John Stewart and John Mullon and Michalis Michael and Ilias Porfyridis",

note = "Publisher Copyright: {\textcopyright} 2022 Asian Pacific Society of Respirology.",

year = "2022",

month = may,

doi = "10.1111/resp.14232",

language = "English (US)",

volume = "27",

pages = "350--356",

journal = "Respirology",

issn = "1323-7799",

publisher = "Wiley-Blackwell",

number = "5",

}

TY - JOUR

T1 - Predicting malignant pleural effusion during diagnostic pleuroscopy with biopsy

T2 - A prospective multicentre study

AU - Grosu, Horiana B.

AU - Kern, Ryan

AU - Maldonado, Fabien

AU - Casal, Roberto

AU - Andersen, Clark R.

AU - Li, Liang

AU - Eapen, Georgie

AU - Ost, David

AU - Jimenez, Carlos

AU - Frangopoulos, Frangiskos

AU - Sabath, Bruce

AU - Vakil, Erik

AU - Schwalk, Audra

AU - Marcoux, Mathieu

AU - Sagar, Ala Eddin

AU - Nasim, Faria

AU - Lin, Julie

AU - Salahudin, Moiz

AU - Arain, Hasan Muhammad

AU - Noor, Laila

AU - Montanez, Diana

AU - Stewart, John

AU - Mullon, John

AU - Michael, Michalis

AU - Porfyridis, Ilias

PY - 2022/5

Y1 - 2022/5

N2 - Background and objective: Pleuroscopy with pleural biopsy has a high sensitivity for malignant pleural effusion (MPE). Because MPEs tend to recur, concurrent diagnosis and treatment of MPE during pleuroscopy is desired. However, proceeding directly to treatment at the time of pleuroscopy requires confidence in the on-site diagnosis. The study's primary objective was to create a predictive model to estimate the probability of MPE during pleuroscopy. Methods: A prospective observational multicentre cohort study of consecutive patients undergoing pleuroscopy was conducted. We used a logistic regression model to evaluate the probability of MPE with relation to visual assessment, rapid on-site evaluation (ROSE) of touch preparation and presence of pleural nodules/masses on computed tomography (CT). To assess the model's prediction accuracy, a bootstrapped training/testing approach was utilized to estimate the cross-validated area under the receiver operating characteristic curve. Results: Of the 201 patients included in the study, 103 had MPE. Logistic regression showed that higher level of malignancy on visual assessment is associated with higher odds of MPE (OR = 34.68, 95% CI = 9.17–131.14, p < 0.001). The logistic regression also showed that higher level of malignancy on ROSE of touch preparation is associated with higher odds of MPE (OR = 11.63, 95% CI = 3.85–35.16, p < 0.001). Presence of pleural nodules/masses on CT is associated with higher odds of MPE (OR = 6.61, 95% CI = 1.97–22.1, p = 0.002). A multivariable logistic regression model of final pathologic status with relation to visual assessment, ROSE of touch preparation and presence of pleural nodules/masses on CT had a cross-validated AUC of 0.94 (95% CI = 0.91–0.97). Conclusion: A prediction model using visual assessment, ROSE of touch preparation and CT scan findings demonstrated excellent predictive accuracy for MPE. Further validation studies are needed to confirm our findings.

AB - Background and objective: Pleuroscopy with pleural biopsy has a high sensitivity for malignant pleural effusion (MPE). Because MPEs tend to recur, concurrent diagnosis and treatment of MPE during pleuroscopy is desired. However, proceeding directly to treatment at the time of pleuroscopy requires confidence in the on-site diagnosis. The study's primary objective was to create a predictive model to estimate the probability of MPE during pleuroscopy. Methods: A prospective observational multicentre cohort study of consecutive patients undergoing pleuroscopy was conducted. We used a logistic regression model to evaluate the probability of MPE with relation to visual assessment, rapid on-site evaluation (ROSE) of touch preparation and presence of pleural nodules/masses on computed tomography (CT). To assess the model's prediction accuracy, a bootstrapped training/testing approach was utilized to estimate the cross-validated area under the receiver operating characteristic curve. Results: Of the 201 patients included in the study, 103 had MPE. Logistic regression showed that higher level of malignancy on visual assessment is associated with higher odds of MPE (OR = 34.68, 95% CI = 9.17–131.14, p < 0.001). The logistic regression also showed that higher level of malignancy on ROSE of touch preparation is associated with higher odds of MPE (OR = 11.63, 95% CI = 3.85–35.16, p < 0.001). Presence of pleural nodules/masses on CT is associated with higher odds of MPE (OR = 6.61, 95% CI = 1.97–22.1, p = 0.002). A multivariable logistic regression model of final pathologic status with relation to visual assessment, ROSE of touch preparation and presence of pleural nodules/masses on CT had a cross-validated AUC of 0.94 (95% CI = 0.91–0.97). Conclusion: A prediction model using visual assessment, ROSE of touch preparation and CT scan findings demonstrated excellent predictive accuracy for MPE. Further validation studies are needed to confirm our findings.

KW - ROSE

KW - malignant pleural effusion

KW - pleurodesis

KW - pleuroscopy

KW - thoracoscopy

KW - touch preparation

UR - http://www.scopus.com/inward/record.url?scp=85124745271&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85124745271&partnerID=8YFLogxK

U2 - 10.1111/resp.14232

DO - 10.1111/resp.14232

M3 - Article

C2 - 35178828

AN - SCOPUS:85124745271

SN - 1323-7799

VL - 27

SP - 350

EP - 356

JO - Respirology

JF - Respirology

IS - 5

ER -

Predicting malignant pleural effusion during diagnostic pleuroscopy with biopsy: A prospective multicentre study

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this