ROSE of touch preparation, CT scan findings predict malignant pleural effusion

Rapid on-site evaluation (ROSE) of touch preparation and presence of pleural nodules/masses on computed tomography (CT) accurately predict malignant pleural effusion (MPE), according to a study.

“Pleuroscopy with pleural biopsy has a high sensitivity for MPE,” the authors said. “Because MPEs tend to recur, concurrent diagnosis and treatment of MPE during pleuroscopy is desired.”

This prospective, observational, multicentre cohort study of 201 consecutive patients undergoing pleuroscopy sought to create a predictive model to estimate the probability of MPE. The authors assessed the probability of MPE with relation to visual assessment, ROSE of touch preparation, and CT scan findings using a logistic regression model.

The model’s prediction accuracy was evaluated using a bootstrapped training/testing approach to estimate the cross-validated area under the receiver operating characteristic curve (AUC).

Of the patients, 103 had MPE. In logistic regression, a higher level of malignancy on visual assessment predicted a greater likelihood of MPE (odds ratio [OR], 34.68, 95 percent confidence interval [CI], 9.17‒131.14; p<0.001). Likewise, a higher level of malignancy on ROSE of touch preparation correlated with a higher chance of MPE (OR, 11.63, 95 percent CI, 3.85‒35.16; p<0.001). The presence of pleural nodules/masses on CT scan was also predictive of MPE (OR, 6.61, 95 percent CI, 1.97‒22.1; p=0.002).

Multivariable analysis of the final pathologic status with relation to visual assessment revealed a cross-validated AUC of 0.94 (95 percent CI, 0.91‒0.97) with ROSE of touch preparation and presence of pleural nodules/masses on CT scan findings.

“Further validation studies are needed to confirm our findings,” the authors said.