Abstract 525P
Background
To develop a predictive scoring system for the diagnosis of malignant pleural effusion in patients with lung cancer.
Methods
Retrospective analysis of pleural fluid cytology was conducted in lung cancer patients with malignant pleural effusion (MPE) between 2018 and 2020. Multivariable logistic regression was used to explore the potential predictors for MPE. The selected logistic coefficients were transformed into a diagnostic predictive scoring system. Internal validation was done using the bootstrapping procedure.
Results
The data of pleural fluid cytology from 99 lung cancer patients with MPE were analyzed. Sixty-four positive pleural cytology patients were found (64.65%). The predictive indicators included ratio of pleural fluid to serum LDH greater than 0.6, ratio of pleural fluid to serum protein greater than 0.5, pleural fluid LDH > 555 IU/L, and pleural fluid sugar > 60 mg/dL. and double tap for pleural cytology were used for the derivation of the diagnostic prediction model. The score-based model showed that the area under the receiver operating characteristic curve was 0.82 (95% CI 0.72-0.92). The developed MPE score ranged from zero to 17. The cut-off point was 11 with 91.67% of specificity, 59.09% of sensitivity, positive predictive value of 0.93, and negative predictive value of 0.55. The measurement of the calibration was illustrated using a calibration plot (p-value = 0.88 for the Hosmer-Lemeshow based goodness of fit). Internal validation with 1,000 bootstrap resampling showed a good discrimination. Table: 525P
| Potential predictors | Odds ratio | 95% CI | p-value | Coefficients | Score |
| Pleural fluid LDH ≤555 IU/L | 1 | reference | - | - | 0 |
| Pleural fluid LDH >555 IU/L | 14.86 | 1.66-133.08 | 0.016 | 2.7 | 5 |
| Pleural fluid sugar ≤60 mg/dL | 1 | reference | - | - | 0 |
| Pleural fluid sugar >60 mg/dL | 63.86 | 5.48-743.97 | 0.001 | 4.16 | 7 |
| Pleural fluid protein/serum protein ratio ≤ 0.5 | 1 | reference | - | - | 0 |
| Pleural fluid protein/serum protein ratio > 0.5 | 1.77 | 0.26-12.14 | 0.561 | 0.57 | 1 |
| Pleural fluid LDH/serum LDH ratio ≤ 0.6 | 1 | reference | - | - | 0 |
| Pleural fluid LDH/serum LDH ratio > 0.6 | 2.33 | 0.28-19.05 | 0.431 | 0.84 | 1 |
| No double tap for pleural cytology | 1 | reference | - | - | 0 |
| Double tap for pleural cytology | 5.1 | 1.16-22.40 | 0.031 | 1.63 | 3 |
Conclusions
The MPE-Lung score, as the diagnostic prediction model can be used in planning for more efficient diagnosis of MPE in lung cancer patients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
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