EVALUATION OF THE DIAGNOSTIC ACCURACY OF A COMPUTED TOMOGRAPHY-BASED SCORING SYSTEM IN THE DIFFERENTIATION BETWEEN MALIGNANT AND BENIGN ΡLEURAL EFFUSION

Abstract

Background: Pleural effusion in particular is considered a sign of an underlying pathology, so it is imperative to search for the underlying cause and find out whether it is a benign or malignant one as they are completely different in their treatment and prognosis. Aim of the work: Our study aiming to appraise the validity and accuracy of contrast-enhanced CT chest as a non-invasive tool to predict the nature of pleural effusion whether benign or malignant using the CT-based scoring system established by Porcel et al. Patients and Methods: This was a retrospective study that involved reviewing the contrast-enhanced CT chest done at the radiodiagnosis department in Ain Shams University Hospitals of 30 adult patients (age >18 years old) with unilateral or bilateral pleural effusion and scoring it according to the Porcel et al CT scoring system while being blinded to the final diagnosis. The total score was then compared to the biopsy or cytology of the patient to determine its accuracy. Results: Analysing the data showed that the highly significant item of the scoring system denoting malignancy was pleural lesions followed by lung masses, liver metastasis, abdominal masses, and absence of pericardial effusion. The cutoff value in our study was found to be total score >7 denoting malignancy with a sensitivity of 94.12%, a specificity of 100%, a PPV of 100, a NPV of 92.2 and AUC = 0.986. On the other hand, the cutoff value of Porcel et al (≥7 denotes malignancy) gave a sensitivity of 94.1%, a specificity of 92.3%, a PPV of 94.12, a NPV of 92.31, and an accuracy of 93.33% in our study while in their study gave a sensitivity of 88%, a specificity of 94%, and AUC = 0.919. Conclusion: This is a straightforward modality by means of chest computed tomography scan with a scoring system, which incorporates the following evaluations: pleural nodulations or pleural thickening, Hepatic metastases, Abdominal metastasis or masses, lung pathology as nodules or masses, pleural encysted loculations, cardiomegaly with or without pericardial fluid. CT Chest with contrast can be consistently applied to differentiate the etiology of pleural effusions with great accuracy yet it does not replace pleural fluid cytology/biopsy as a requirement for verification. Additional studies reviewing this CT scoring system are recommended.