Pleural effusion: breast and lung cancer were the commonest malignant causes.

Clinical bottom line (level 4)

  1. The commonest malignancies in men with pleural effusions were lung, followed by lymphoma/ leukaemia, and GI tract.
  2. The commonest malignancies in women with pleural effusions were breast followed by female genital tract, and lung.
  3. No primary site was found in around a tenth of cases.
Johnston et al: Cancer 1985; 56: 905-909
Expires April 2003

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, USA, 1970 to 1983

472 patients (aged ?, 60% male) with pleural effusions containing cancer cells



Outcomes studied:
  • men: lung
  • men: lymphoma/ leukaemia
  • men: GI tract
  • men: GU tract
  • men: melanoma
  • men: mesothelioma
  • men: other tumours
  • men: primary site unknown
  • women: breast
  • women: female genital tract
  • women: lung
  • women: lymphoma/ leukaemia
  • women: GI tract
  • women: melanoma
  • women: urinary tract
  • women: other tumours
  • women: primary site unknown

    • final diagnosis: surgical pathology or autopsy records; if unavailable clinical records

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    men: lung ? 140/285 49%
    (43% to 55%)
    men: lymphoma/ leukaemia ? 60/285 21%
    (16% to 26%)
    men: GI tract ? 20/285 7.0%
    (4.1% to 10%)
    men: GU tract ? 17/285 6.0%
    (3.2% to 8.7%)
    men: melanoma ? 4/285 1.4%
    (0.0% to 2.8%)
    men: mesothelioma ? 3/285 1.1%
    (0.0% to 2.2%)
    men: other tumours ? 10/285 3.5%
    (1.4% to 5.6%)
    men: primary site unknown ? 31/285 11%
    (7.3% to 15%)
    women: breast ? 70/187 37%
    (31% to 44%)
    women: female genital tract ? 38/187 20%
    (15% to 26%)
    women: lung ? 28/187 15%
    (9.9% to 20%)
    women: lymphoma/ leukaemia ? 15/187 8.0%
    (4.1% to 12%)
    women: GI tract ? 8/187 4.3%
    (1.4% to 7.2%)
    women: melanoma ? 6/187 3.2%
    (0.7% to 5.7%)
    women: urinary tract ? 2/187 1.1%
    (0.0% to 2.5%)
    women: other tumours ? 3/187 1.6%
    (0.0% to 3.4%)
    women: primary site unknown ? 17/187 9.1%
    (5.0% to 13%)

    Citation

    1. Johnston WW, et al: The malignant pleural effusion: a review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients. Cancer 1985; 56: 905-909
    Contributor: Donald Stanley and Chris Ball, April 2000
    Reviewer:

    Clinical Question.
    Patient pleural effusion
    Intervention or Exposure prevalence
    Outcome malignancies