Using Pleural Effusions to Diagnose Cancer

Study Overview
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Brief Summary
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Pleural effusions (PE) are common conditions that signal either infection or cancer. The investigators aim to develop, validate, and prospectively assess the MAPED score, a clinical score that predicts malignancy at admission. This tool will assist clinicians all over the world to rapidly assess the probability of an effusion being malignant within 4 hours of admission.

Detailed Description
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Background: Pleural effusions (PE) are common conditions that signal either pleural-disseminated infection or cancer. While these diagnoses bear tremendous importance for patients, they require invasive procurement of pleural tissues and/or cells and time. Simple and rapid diagnostic markers of pleural malignancy at admission that streamline diagnostic and treatment efforts remain unidentified. Objective: To develop, validate, and prospectively assess markers of malignancy of PE at admission. Methods: A prospective cohort of patients with PE from different etiologies will be recruited stating on 11.21.2013 and prospectively ending on 11.21.2023. Data will be collected within 4 hours of admission including history, chest X-ray, and blood and pleural fluid (PF) cell counts and basic biochemistry. Pleural fluid and serum will be biobanked for future analyses. Patients will sign informed consent forms. Diagnosis will be confirmed using standard microbiology, cytology, histology, and imaging techniques. Patients undiagnosed within a month will be excluded. Variables will be entered into binary regression and receiver-operator analyses using malignancy as the target to develop the MAPED score, a clinical score that predicts malignancy at admission. MAPED will be retrospectively validated in separate published cohorts from the first therapeutic interventions in malignant effusion (TIME) 1-3 trials from Oxford UK. Data will be censored and analyzed three times, at 40-month intervals since study initiation.

Official Title
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Clinical Identification of Malignant Pleural Effusions in the Emergency Department

Conditions
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Pleural Effusion

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pleural effusion Hospital admission No previous pleural procedure Age > 18 years No previous chemoradiotherapy No antibiotic therapy during previous trimester All history, chest X-ray, and pleural and blood cell counts and biochemistry entry data obtained within 4 hours after admission Exclusion Criteria: No diagnosis at one month post-admission No informed consent provided Age < 18 years History, chest X-ray, or pleural and blood cell counts and biochemistry entry data obtained later than 4 hours after admission

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Benign Pleural Effusion<br>Patients that will be diagnosed within a month from admission with any non-malignant cause of pleural effusion, including but not limited to effusions caused by common or tuberculous or fungal infection, heart failure, etc. Documentation of the etiology will be required for inclusion in this group, including but not limited to bacteriology, virology, PCR, radiology, heart echocardiogram or catheterization, as appropriate. | |
| Malignant Pleural Effusion<br>Patients that will be diagnosed within a month from admission with any malignant cause of pleural effusion, including but not limited to effusions caused by lung, breast, colon, ovary, mesothelial, hematopoietic, prostate, or any other cancer. Diagnosis will be based on verification of the presence of malignant cells in the pleural fluid or tissues. Patients with cancer and an effusion without such documentation will be assigned to the benign group if an alternative diagnosis is made. In any other case, they will be excluded. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diagnosis of Malignancy | Cytologic or histologic evidence of malignant cells or tissues in the pleural space. | One month post-admission | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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malignant, cancer, simple bedside test, rapid, score, widely available, feasible