Author of

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  P3.06 - Poster Session 3 - Prognostic and Predictive Biomarkers (ID 178)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Biology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12478

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    P3.06-038 - New scoring system assessing the probability of malignancy as the cause of large pericardial effusion is able to improve the diagnostic algorithm of neoplastic pericarditis. (ID 2750)

    09:30 - 09:30  |  Author(s): W. Tomkowski
    • Abstract

    Background
    Neoplastic pericarditis is found in 60-80% of patients (pts) with large pericardial effusion (pe) (>2 cm on echocardiography). The most frequent causes of neoplastic pe are metastatic lung or breast cancer. Malignant pe is combined with high relapse rate after pericardiocentesis and poor prognosis. Early recognition of malignant pe and intensive local (+/-) systemic treatment is able to improve life expectancy. Nevertheless in 30-40% of pts the malignant cause of pe is not recognized during the first episode of disease. The aim of the study was to introduce the new scoring system assessing the probability of malignant pe in the pts requiring pericardial fluid drainage due to large pe/tamponade.

    Methods
    146 pts, median age 57 years (21-88), 80 with benign cause of pe, 66 with neoplastic cause of pe ( positive pe cytology or neoplastic infiltration in pericardial biopsy specimen) treated in the National Institute of Tuberculosis and Lung Diseases in 1982 - 2008 entered the study. Metastatic lung cancer was diagnosed in 67% of neoplastic pe.

    Results
    Based on previous results, the most important features distinguishing between neoplastic and benign pe were: cardiac tamponade on echocardiographic examination, HR>90 beats/min on ECG, enlarged mediastinal lymph nodes (>1cm) on chest CT scan, CEA> 5ng/ml in pe, Cyfra 21-1>95 ng/ml in pe, bloody pe. The sensitivity, specificity, PPV and NPV are listed in table 1.

    Parameter Diag. value	HR>90/min	Cardiac tamponade	CEA>5 ng/ml (pe)	Cyfra 21-1>95 ng/ml (pe)	Bloody pe	Lymph nodes>1 cm (CT)
    sensitivity	0.82	0.67	0.63	0.64	0.86	0.93
    specificity	0.55	0.65	0.94	0.95	0.57	0.70
    PPV	0.60	0.61	0.91	0.93	0.66	0.66
    NPV	0.79	0.70	0.71	0.71	0.80	0.94

    The original scoring system (-3 up to + 3 points) was developed based on PPV and NPV of the above mentioned parameters. The diagnostic value of the proposed scoring system was high, ( ROC: AUC 0.926 95%CI 0.85-0.96) and exceeding the value of single parameters (at a cut off of 0 points – sensitivity was 0.84 and specificity - 0.91).

    Conclusion
    Assessment of the probability of malignant pe according to the proposed original scoring system was able to improve the diagnostic algorithm based on single parameters, thus indicating pts in whom more invasive diagnostic methods should be applied to recognize malignant pe.