Pleural effusion: bronchoscopy could not rule out malignancy.

Clinical bottom line (level 4)

  1. A positive fibreoptic bronchoscopy diagnosed malignancy in patients with pleural effusions, but a negative one did not rule out malignancy (LR-0.45) .
Chang and Perng: Archives of Internal Medicine 1989; 149: 855-857
Expires October 2003

The study

Setting: Veterans' Hospital, Taiwan

140 patients (aged range 27 to 82 years; mean 55, 82% male) pleural effusions of unknown cause

?independent ?blinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • cytology from thoracocentesis and closed pleural biopsy (using Abram's needle). Follow-up for patients with negative results
Diagnostic test: fibreoptic bronchoscopy with bronchial brushings taken

The evidence

pre-test probability of malignancy: 68%, (95% CI: 60% to 76%)

diagnostic test malignancy other cause LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
bronchoscopy positive 52 0 inf
(8.5 to inf) 		100% 0.45
(0.36 to 0.56) 		49%
total 95 45

Comments

  1. No false negative results were reported - therefore it was assumed that no false negatives occurred.

Citation

  1. Chang C, and Perng R-P: the role of fibreoptic bronchoscopy in evaluating the causes of pleural effusions. Archives of Internal Medicine 1989; 149: 855-857
Search Terms: reference from Pleural effusion chapter in 'Quick Consult Manual to Evidence-based Medicine' by Lee, Hsu and Stasior: publd. Lippincott-Raven
Contributor: Chris Ball and Clare Wotton, October 2000
Reviewer:

Clinical Question.
Patient pleural effusion
Intervention or Exposure fibreoptic bronchoscopy
Outcome malignancy