Clinico‐cytopathologic analysis of 574 Pericardial Effusion Specimens: Application of the international system for reporting serous fluid cytopathology (ISRSFC) and long‐term clinical follow‐up

Figures

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  FIGURE 1. Representative images of negative for malignancy (NFM), atypia of undetermined significance (AUS), and suspicious for malignancy (SFM) in pericardial fluid. (A) NFM shows reactive mesothelial cell and lymphocytes. (B, C) AUS presents reactive mesothelial cells and occasional large atypical cells. A few atypical cells show moderate N/C ratio with hypochromatin. (D) SFM shows atypical cells with high N/C ratio, macronucleoli, and cytoplasmic mucin

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  FIGURE 2. Representative images of malignant pericardial effusion. (A) Adenocarcinoma of the lung, (B) invasive ductal carcinoma of the breast, (C) gastric adenocarcinoma, (D) thymic carcinoma. (Papanicolaou stain, original magnification, ×400)

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  FIGURE 3. Overall survival (OS) analysis according to an initial diagnosis and follow‐up data. (A) The presence of malignant cells in pericardial effusion showed significant differences in OS compared to absence of malignant cells (p < 0.001). (B) The follow‐up data were recategorized in benign and malignant group. The malignant group had poor prognosis than the benign group (p < 0.001)

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  FIGURE 4. (A) Boxplot of the time interval between the initial diagnosis and first occurrence of malignant pericardial effusion according to the primary site. (B) Boxplot of the time interval between the first diagnosis of a malignant pericardial effusion and the last follow‐up date according to the primary site

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  FIGURE 5. Kaplan–Meier survival analysis. (A) Overall survival rate according to the primary site. Lung cancer shows a poorer prognosis compared to the breast cancer cases (p < 0.001, log‐rank test). The specimens include lung cancer (n = 79), breast cancer (n = 17), gastric cancer (n = 6), and others (n = 30). The “others” include colorectal cancer, hepato‐biliary cancer, tonsillar cancer, hematologic malignancy, female genital tract, and metastasis of unknown origin. (B) Survival rate according to the primary site after the occurrence of a malignant pericardial effusion