Challenges of Pleural Aspirate Cytology: A 5-year Review

Abstract

Introduction: Pleural effusion is a common medical condition, and the aspiration of the pleural cavity is a minimally invasive, cheap, and simple technique with the potential to achieve a clinically useful diagnosis. Challenges in the optimization of this investigative modality, however, occur in our everyday practice. Aim: The purpose of this review was to highlight the challenges in the cytopathological evaluation of pleural aspirates in our environment. Materials and Methods: The data regarding pleural fluid (PF) aspirates received for cytopathological evaluation between January 1, 2010, and December 31, 2014, were retrieved from departmental records and analyzed. Results: PF aspirates from 69 patients, with a male–female ratio of 1:1.03, were studied. The modal age group was 30–39 years, and the mean age was 45 ± 21.40 years. Of 69 smears, 40.6% were categorized as unsatisfactory/nondiagnostic, 44.9% were in the “negative for malignancy/normal/ benign” category, 1.4% were in the “atypical‑favor reactive” category, 4.3% were “atypical‑suspicious for malignancy” and 8.7% were “positive for malignancy.” The male–female ratio of patients with malignant pleural effusions was 1:5, and 66.7% of malignant smears were from persons above 50 years. Thirty‑nine percent of total smears wear “inflammatory.” The large number of unsatisfactory smears is a major challenge. Conclusion: Pleural aspirate cytology can be a useful investigative tool with the potential for definitive diagnosis or other useful information for clinical decision‑making. To maximize its diagnostic potential in our environment, however, the current challenges must be overcome.