Key result
The combination of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU was significantly associated with malignancy-related pericardial effusion, yielding 89.6% specificity and 85.7% positive predictive value.
Why the study?
The study evaluated malignancy according to the characteristics of pericardial fluid in symptomatic patients undergoing pericardiocentesis and CT.
Do pericardial fluid glucose levels and CT attenuation values help diagnose malignancy-related pericardial effusion in symptomatic patients?
Observational (n=97)
No
Do pericardial fluid glucose levels and CT attenuation values help diagnose malignancy-related pericardial effusion in symptomatic patients?
Lower pericardial fluid glucose levels combined with higher CT attenuation values can help differentiate malignancy-related pericardial effusion from non-malignant causes.
Answers are grounded in this paper and cite their sources.
May support malignancy differentiation in pericardial effusion; hypothesis-generating and leaves open prospective validation.
BACKGROUND: We evaluated malignancy according to the characteristics of pericardial fluid in symptomatic Japanese patients undergoing pericardiocentesis and computed tomography (CT). METHODS: This was a retrospective, single-center, observational study of 125 symptomatic patients undergoing pericardiocentesis. The patients were classified into two groups: a malignancy group and a non-malignancy group, according to the primary disease and cytology of the pericardial effusion (PE). We compared the pericardial fluid sample and CT measurements between both groups. RESULTS: All patients were diagnosed as having exudative PE by Light's criteria. PE with malignant cells was demonstrated in 76.8% of the malignancy group patients. Pericardial to serum lactate dehydrogenase (LDH) ratio > 0.6, as one of Light's criteria, was associated with malignancy (p = 0.017). Lower serum brain natriuretic peptide (BNP) concentration was also associated with malignancy (BNP: 126.9 ± 89.8 pg/ml vs 409.2 ± 97.7 pg/ml, malignancy vs non-malignancy groups, respectively; p = 0.037). A significant difference was observed in pericardial fluid glucose level between the malignancy and non-malignancy groups (pericardial fluid glucose: 78.24 ± 48.29 mg/dl vs 98.41 ± 44.85, respectively; p = 0.048). Moreover, CT attenuation values (Hounsfield units (HU)) tended to be higher in the malignancy group vs the non-malignancy group (22.7 [interquartile range (IQR), 17.4-26.0] vs 17.4 [IQR, 13.7-26.4], respectively; p = 0.08). The sensitivity and specificity of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 40.9% and 89.6%, respectively, in the malignancy group. The positive- and negative predictive values of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 85.7% and 50.0%, respectively, in the malignancy group. Pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were cutoff values associated with malignancy (p = 0.012). CONCLUSIONS: Lower pericardial fluid glucose level with higher CT attenuation values may suggest malignancy-related PE.
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Nakamura et al. (2021) conducted an observational in Pericardial effusion (n=97). Pericardial fluid glucose ≤ 70 mg/dl and CT attenuation > 20 HU vs. Pericardial fluid glucose > 70 mg/dl or CT attenuation ≤ 20 HU was evaluated on Diagnosis of malignancy-related pericardial effusion (p=0.012). The combination of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU was significantly associated with malignancy-related pericardial effusion, yielding 89.6% specificity and 85.7% positive predictive value.
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