MesotheliomaSupport: Phase 1 Session 1 baseline — 4 citation metadata fabs corrected vs PubMed efetch (Pairman/Maze, Mansour, Grosu, Ceruti); body-prose CTA stripped from ES per wiki-no-promo (CLEO #9185 dim-1=100, dim-2=100). Commits 865d5be + ab24c15.

2026-05-25T03:54:12Z

Phase 1 Session 1 baseline — 4 citation metadata fabs corrected vs PubMed efetch (Pairman/Maze, Mansour, Grosu, Ceruti); body-prose CTA stripped from ES per wiki-no-promo (CLEO #9185 dim-1=100, dim-2=100). Commits 865d5be + ab24c15.

New page

{{#seo:
|title=Pleural Effusion in Mesothelioma: Causes, Diagnosis, and Treatment
|description=Pleural effusion is the presenting sign in 80%+ of pleural mesothelioma patients. Cytology sensitivity is ~33% — VATS biopsy is the gold standard.
|keywords=pleural effusion, mesothelioma, malignant pleural effusion, thoracentesis, cytology, VATS biopsy, pleurodesis, indwelling pleural catheter
|author=Danziger & De Llano Medical Editorial Team
|published_time=2026-05-25
|type=Article
|twitter_card=summary_large_image
}}

{| class="infobox" style="width:280px; float:right; margin:0 0 1em 1em; border:2px solid #1a5276; border-radius:8px; overflow:hidden;"
|-
! colspan="2" style="background:#1a5276; color:white; padding:12px; font-size:1.1em; text-align:center;" | Pleural Effusion in Mesothelioma
|-
! style="padding:10px;" | Presenting sign in
| style="padding:10px;" | '''80%+''' of pleural mesothelioma patients<ref name="bianco_2018" />
|-
! style="padding:10px;" | Cytology sensitivity
| style="padding:10px;" | '''~33%''' for mesothelioma (95% CI 11.8–61.6%)<ref name="pairman_2022" />
|-
! style="padding:10px;" | Definitive diagnosis
| style="padding:10px;" | VATS pleural biopsy ('''>95%''' sensitivity)<ref name="bianco_2018" />
|-
! style="padding:10px;" | Recurrence risk markers
| style="padding:10px;" | Higher fluid LDH; positive cytology<ref name="grosu_2019" />
|-
! style="padding:10px;" | Management options
| style="padding:10px;" | Therapeutic thoracentesis; indwelling pleural catheter (IPC); chemical pleurodesis<ref name="ceruti_2018" />
|-
| colspan="2" style="background:#1a5276; padding:10px; text-align:center;" | [https://dandell.com/contact-us/ Free Case Review →]
|}

== Executive Summary ==

'''Pleural effusion''' — abnormal fluid accumulation between the lung and the chest wall — is the most common presenting feature of malignant pleural mesothelioma, found in '''more than 80%''' of patients at diagnosis.<ref name="bianco_2018" /> The fluid is typically unilateral and exudative, accompanied by progressive dyspnea, non-pleuritic chest pain, and cough; many patients are referred for evaluation only after the effusion has recurred following an initial drainage.<ref name="sterman_2005" /> Tumor-driven inflammation, lymphatic obstruction, and VEGF-mediated capillary leak are the dominant mechanisms.<ref name="sterman_2005" />

Pleural fluid cytology, although the easiest first test to perform, is the '''least reliable''' diagnostic tool in mesothelioma of any malignancy that involves the pleura. A 2023 systematic review and meta-analysis in ''Thorax'' confirmed cytology has the lowest pooled sensitivity for mesothelioma among all pleural malignancies.<ref name="kassirian_2023" /> A 2022 prospective cohort published in the ''Internal Medicine Journal'' reported cytology sensitivity of only '''33.3%''' (95% CI 11.8–61.6%) for mesothelioma compared with ~90% for breast and ~79% for lung adenocarcinoma in the same patient population.<ref name="pairman_2022" /> Sarcomatoid mesothelioma is particularly resistant to cytologic diagnosis and effectively requires tissue biopsy.<ref name="kassirian_2023" />

When cytology is negative or equivocal — especially in a patient with a history of asbestos exposure and recurrent unilateral effusion — the diagnostic workup must escalate. '''Video-assisted thoracoscopic surgery (VATS) pleural biopsy''' is the gold standard, achieving diagnostic sensitivity above 95%.<ref name="bianco_2018" /> Combined immunohistochemistry — calretinin, WT-1, cytokeratin 5/6, and D2-40 positivity together with CEA, TTF-1, claudin-4, and BerEP4 negativity — plus '''BAP1''' and '''CDKN2A/MTAP''' loss assessment is the current standard for distinguishing malignant mesothelioma from reactive mesothelial proliferations.<ref name="mansour_2023" /><ref name="nabeshima_2022" />

For families confronting a mesothelioma diagnosis that began as "fluid on the lung," the legal compensation pathways — federal asbestos bankruptcy trust funds, civil personal injury and wrongful death lawsuits, and VA disability claims for veterans — are time-sensitive. State statutes of limitations begin running at diagnosis, and trust fund claims have separate, shorter deadlines that can preclude recovery if missed.

== At-a-Glance ==

'''Pleural effusion in mesothelioma at a glance:'''

* '''Most common presenting sign''' — unilateral pleural effusion is found in over 80% of pleural mesothelioma patients at diagnosis<ref name="bianco_2018" />
* '''Cytology sensitivity is ~33%''' — meta-analysis confirms pleural fluid cytology has the lowest diagnostic sensitivity for mesothelioma of any malignancy that involves the pleura<ref name="kassirian_2023" /><ref name="pairman_2022" />
* '''Sarcomatoid subtype defies cytology''' — the sarcomatoid histologic variant is particularly resistant to cytologic diagnosis and generally requires tissue biopsy<ref name="kassirian_2023" />
* '''VATS biopsy is the gold standard''' — video-assisted thoracoscopic surgery achieves diagnostic sensitivity above 95% when cytology is negative<ref name="bianco_2018" />
* '''Pleural fluid mesothelin is an adjunctive biomarker''' — elevated mesothelin in undiagnosed effusion has clinical value alongside cytology<ref name="davies_2009" />
* '''Australian cohort yield was 32%''' — a tertiary-center retrospective reported pleural fluid cytology was diagnostic in only 32% of mesothelioma cases versus 87.9% for other malignancies<ref name="loveland_2018" />
* '''Recurrence is driven by tumor biology''' — higher pleural fluid LDH and positive cytology independently increase the hazard of effusion recurrence after drainage<ref name="grosu_2019" />
* '''IHC requires the full panel''' — diagnostic confirmation needs calretinin + WT-1 + cytokeratin 5/6 + D2-40 positive with CEA + TTF-1 + claudin-4 + BerEP4 negative, plus BAP1 and CDKN2A/MTAP loss assessment<ref name="mansour_2023" /><ref name="nabeshima_2022" />
* '''Both IPC and pleurodesis are valid recurrence options''' — indwelling pleural catheter and chemical pleurodesis both control recurrent effusion; choice depends on lung re-expansion, performance status, and patient preference<ref name="ceruti_2018" />
* '''Effusion as presentation correlates with earlier-stage disease''' — patients diagnosed via effusion presentation tend to have a better prognosis than those who first present with solid-tumor signs<ref name="sterman_2005" />

== Key Facts ==

{| class="wikitable" style="width:100%; margin:1em 0; border-collapse:collapse; border:2px solid #1a5276;"
|-
! style="background:#1a5276; color:white; padding:12px; text-align:left; width:40%;" | Measure
! style="background:#1a5276; color:white; padding:12px; text-align:left;" | Finding (Source)
|-
| style="padding:10px; font-weight:bold; border-bottom:1px solid #dee2e6;" | Effusion as presenting feature
| style="padding:10px; border-bottom:1px solid #dee2e6;" | '''>80%''' of pleural mesothelioma patients (Bianco et al., ''J Thorac Dis'', 2018)<ref name="bianco_2018" />
|-
| style="padding:10px; font-weight:bold; border-bottom:1px solid #dee2e6;" | Cytology sensitivity — mesothelioma
| style="padding:10px; border-bottom:1px solid #dee2e6;" | '''33.3%''' (95% CI 11.8–61.6%) in a 2022 prospective cohort (Pairman et al., ''Intern Med J'', 2022)<ref name="pairman_2022" />
|-
| style="padding:10px; font-weight:bold; border-bottom:1px solid #dee2e6;" | Cytology sensitivity — lung adenocarcinoma (comparator)
| style="padding:10px; border-bottom:1px solid #dee2e6;" | '''~79%''' in the same Pairman cohort<ref name="pairman_2022" />
|-
| style="padding:10px; font-weight:bold; border-bottom:1px solid #dee2e6;" | Cytology sensitivity — breast cancer (comparator)
| style="padding:10px; border-bottom:1px solid #dee2e6;" | '''~90%''' in the same Pairman cohort<ref name="pairman_2022" />
|-
| style="padding:10px; font-weight:bold; border-bottom:1px solid #dee2e6;" | Pooled cytology sensitivity (meta-analysis)
| style="padding:10px; border-bottom:1px solid #dee2e6;" | Lowest of all pleural malignancies (Kassirian et al., ''Thorax'', 2023, systematic review and meta-analysis)<ref name="kassirian_2023" />
|-
| style="padding:10px; font-weight:bold; border-bottom:1px solid #dee2e6;" | VATS pleural biopsy sensitivity
| style="padding:10px; border-bottom:1px solid #dee2e6;" | '''>95%''' diagnostic sensitivity (current standard, Bianco et al., 2018)<ref name="bianco_2018" />
|-
| style="padding:10px; font-weight:bold; border-bottom:1px solid #dee2e6;" | Australian tertiary-center yield (mesothelioma)
| style="padding:10px; border-bottom:1px solid #dee2e6;" | '''32%''' versus 87.9% for other malignancies (Loveland et al., ''Intern Med J'', 2018)<ref name="loveland_2018" />
|-
| style="padding:10px; font-weight:bold; border-bottom:1px solid #dee2e6;" | Recurrence risk factor 1
| style="padding:10px; border-bottom:1px solid #dee2e6;" | Higher pleural fluid LDH at thoracentesis (Grosu et al., ''Respirology'', 2019)<ref name="grosu_2019" />
|-
| style="padding:10px; font-weight:bold; border-bottom:1px solid #dee2e6;" | Recurrence risk factor 2
| style="padding:10px; border-bottom:1px solid #dee2e6;" | Positive initial cytology (Grosu et al., 2019)<ref name="grosu_2019" />
|-
| style="padding:10px; font-weight:bold; border-bottom:1px solid #dee2e6;" | Adjunctive biomarker
| style="padding:10px; border-bottom:1px solid #dee2e6;" | Pleural fluid mesothelin (Davies et al., ''Am J Respir Crit Care Med'', 2009)<ref name="davies_2009" />
|-
| style="padding:10px; font-weight:bold; border-bottom:1px solid #dee2e6;" | Required IHC positive markers
| style="padding:10px; border-bottom:1px solid #dee2e6;" | Calretinin, WT-1, cytokeratin 5/6, D2-40 (Nabeshima et al., ''Pathol Int'', 2022)<ref name="nabeshima_2022" />
|-
| style="padding:10px; font-weight:bold;" | Required IHC negative markers and loss
| style="padding:10px;" | CEA, TTF-1, claudin-4, BerEP4 negative; BAP1 and CDKN2A/MTAP loss assessed (Mansour et al., ''Cytopathology'', 2023; Nabeshima et al., 2022)<ref name="mansour_2023" /><ref name="nabeshima_2022" />
|}

== Why Does Mesothelioma Cause Pleural Effusion? ==

Malignant pleural effusion in mesothelioma reflects three overlapping mechanisms acting on the pleural space simultaneously. First, tumor cells line both the visceral and parietal pleura diffusely, producing a chronic '''inflammatory response''' that increases the permeability of pleural capillaries. Second, infiltrating tumor obstructs the network of '''lymphatic stomata''' along the diaphragmatic and mediastinal parietal pleura that normally drain pleural fluid into the systemic circulation; with that outflow blocked, fluid produced at a normal rate cannot be absorbed. Third, '''vascular endothelial growth factor (VEGF)''' produced by mesothelioma cells drives further capillary leakage of plasma proteins into the pleural space.<ref name="sterman_2005" />

The resulting fluid is almost always '''exudative''' by Light's criteria (high protein and lactate dehydrogenase relative to serum) and almost always '''unilateral''' — bilateral effusions early in the disease course point away from mesothelioma and toward heart failure, lymphoma, or a primary lung adenocarcinoma with pleural spread. As tumor burden grows, the effusion becomes more rapid to re-accumulate after drainage and more difficult to control. The clinical experience is progressive shortness of breath, especially on exertion, accompanied by a non-pleuritic chest discomfort that patients often describe as "heaviness" rather than sharp pain.<ref name="sterman_2005" /><ref name="bianco_2018" />

== How Is Mesothelioma Pleural Effusion Diagnosed? ==

The standard workup begins with imaging — chest X-ray and then computed tomography (CT) of the chest — and a '''diagnostic thoracentesis''' to obtain fluid for analysis. The fluid is sent for cell count and differential, biochemistry to establish exudative status by Light's criteria, microbiology to exclude empyema, and '''cytology''' to look for malignant cells.<ref name="bianco_2018" />

The problem with cytology in mesothelioma is well-documented. The 2023 ''Thorax'' systematic review and meta-analysis by Kassirian and colleagues — the largest synthesis of this question to date — found that pleural fluid cytology has the '''lowest diagnostic sensitivity for mesothelioma''' of all pleural malignancies, with sarcomatoid mesothelioma "generally preclud[ing] cytology diagnosis" entirely.<ref name="kassirian_2023" /> A 2022 prospective single-center series by Pairman et al. quantified this gap with a head-to-head comparison: in the same patient population, pleural fluid cytology was diagnostic for breast cancer in roughly 90% of cases and for lung adenocarcinoma in roughly 79%, but for mesothelioma in only '''33.3%''' (95% CI 11.8–61.6%).<ref name="pairman_2022" /> A 2018 Australian retrospective cohort at a tertiary referral center reported similar numbers — cytology yield of '''32%''' for mesothelioma versus '''87.9%''' for other malignancies in their effusion database.<ref name="loveland_2018" />

When cytology is negative or equivocal, '''pleural fluid mesothelin''' — measured by ELISA on the same fluid sample — adds adjunctive diagnostic value. Davies and colleagues demonstrated in 2009 that elevated pleural fluid mesothelin in undiagnosed pleural effusions independently raises the pretest probability of mesothelioma, helping clinicians decide whether to escalate to biopsy.<ref name="davies_2009" /> A 2021 review by Eccher et al. in ''Cancer Cytopathology'' summarized the diagnostic biomarkers usable on effusion cytology, noting sensitivities in the 30%-plus range for several individual markers and a stronger combined performance when several are run together.<ref name="eccher_2021" />

== When Should Suspicion Escalate to Biopsy? ==

Clinical context drives escalation. A patient with a '''documented asbestos exposure history''' (occupational, military, or take-home household) who presents with a unilateral pleural effusion — especially if accompanied by CT findings of pleural thickening, nodularity, or pleural plaques — should be considered to have mesothelioma until biopsy proves otherwise, regardless of cytology results.<ref name="bianco_2018" /> '''Recurrent effusion''' after an initial therapeutic drainage in such a patient is itself a strong signal that pushes the workup beyond cytology.

The definitive procedure is '''video-assisted thoracoscopic surgery (VATS) pleural biopsy''', which permits direct visualization of the pleural surface and targeted multi-site biopsies. Diagnostic sensitivity is above 95% — effectively a gold standard.<ref name="bianco_2018" /> Less invasive alternatives include image-guided percutaneous pleural biopsy (CT- or ultrasound-guided cutting-needle biopsy), which performs well when CT identifies a discrete pleural target. The Ceruti et al. 2018 review of endoscopic diagnosis and management catalogs the relative roles of medical thoracoscopy, semi-rigid pleuroscopy, and VATS in modern practice.<ref name="ceruti_2018" />

Tissue diagnosis enables the full immunohistochemistry panel. The current standard requires '''calretinin, WT-1, cytokeratin 5/6, and D2-40 positive''' (markers of mesothelial origin) combined with '''CEA, TTF-1, claudin-4, and BerEP4 negative''' (markers that would point instead to adenocarcinoma).<ref name="nabeshima_2022" /> Crucially, distinguishing '''malignant''' mesothelioma from a '''reactive''' mesothelial proliferation — which can look morphologically similar — requires demonstration of '''BAP1 loss''' and/or '''CDKN2A/MTAP loss''', both detectable by immunohistochemistry and confirmed by FISH or sequencing in difficult cases.<ref name="nabeshima_2022" /><ref name="mansour_2023" /> Without these molecular markers, a benign-appearing biopsy can be misclassified.

== How Is Recurrent Pleural Effusion Managed? ==

Pleural effusion in mesothelioma almost always recurs after a single drainage. The 2019 Grosu et al. analysis identified two independent risk factors for recurrence: '''higher pleural fluid LDH''' at the initial thoracentesis and '''positive cytology''' at that same procedure.<ref name="grosu_2019" /> Practical implication: patients with either factor should be planned for definitive control of the effusion rather than serial drainages.

Two definitive control options are widely used:

# '''Indwelling pleural catheter (IPC)''' — a small tunneled drainage catheter placed under local anesthesia and managed at home, allowing the patient or a caregiver to drain a controlled volume of fluid every few days. IPC is well-tolerated, can be placed at the same encounter as diagnostic thoracoscopy, and may produce '''spontaneous pleurodesis''' in 30–50% of patients over weeks to months as pleural surfaces inflame and fuse around the catheter.
# '''Chemical pleurodesis''' — instillation of a sclerosing agent (most commonly graded talc) into the pleural space, intended to fuse the visceral and parietal pleura and obliterate the space in which fluid can re-accumulate. Pleurodesis requires the lung to be capable of re-expanding to the chest wall — a trapped lung (where mesothelioma rind prevents re-expansion) is a contraindication and often pushes the choice toward IPC.<ref name="ceruti_2018" />

Choice between IPC and pleurodesis depends on '''lung re-expansion capacity''' on post-drainage imaging, '''patient performance status''', '''expected survival''' (IPC is well-suited to limited-prognosis patients who prefer to avoid hospitalization), and '''patient preference''' around daily care. Both approaches reduce hospital re-admissions for recurrent dyspnea compared with serial therapeutic thoracenteses.<ref name="ceruti_2018" />

== Frequently Asked Questions ==

=== Is fluid on the lung always cancer? ===

No. Pleural effusion has many non-cancerous causes including congestive heart failure (the single most common cause), pneumonia (parapneumonic effusion), pulmonary embolism, cirrhosis, and post-cardiac surgery effusion. What makes mesothelioma-related effusion distinct is the combination of '''unilateral''' presentation, '''exudative''' biochemistry, progressive recurrence after drainage, and a clinical history of '''asbestos exposure'''. When these features cluster together, mesothelioma must be ruled out by biopsy even if cytology is negative.<ref name="bianco_2018" />

=== Why does cytology miss so many mesothelioma cases? ===

Mesothelioma cells in pleural fluid can look morphologically similar to reactive mesothelial cells, which routinely shed into the pleural space in any inflammatory effusion. Without immunohistochemistry, even an experienced pathologist may report the cytology as "atypical mesothelial cells, suspicious but not diagnostic." Sarcomatoid mesothelioma is even harder — sarcomatoid cells exfoliate poorly into fluid, so the cell-block preparation often contains very few diagnostic cells. The 2023 ''Thorax'' meta-analysis quantified this as the lowest pooled cytology sensitivity of any pleural malignancy.<ref name="kassirian_2023" /><ref name="pairman_2022" />

=== Does a negative cytology rule out mesothelioma? ===

No. A negative pleural fluid cytology in a patient with asbestos exposure history and a recurrent unilateral effusion is '''not''' adequate to rule out mesothelioma. The standard of care is to proceed to '''pleural biopsy''' — preferably VATS — in this scenario.<ref name="bianco_2018" /><ref name="kassirian_2023" />

=== What is the role of pleural fluid mesothelin? ===

Pleural fluid mesothelin (measured by ELISA) is an adjunctive biomarker that adds clinical value when cytology is equivocal. Elevated levels independently raise the pretest probability of mesothelioma in an undiagnosed effusion and can inform the decision to escalate to biopsy.<ref name="davies_2009" /> It is not a stand-alone diagnostic test — biopsy with full IHC remains required for definitive diagnosis.

=== Indwelling pleural catheter or pleurodesis — which is better? ===

Neither is universally better; the choice is clinical. '''Pleurodesis''' requires the lung to be able to re-expand and is a one-time procedure intended to permanently obliterate the pleural space. '''Indwelling pleural catheter (IPC)''' works even when the lung cannot fully re-expand (a "trapped lung," common in advanced mesothelioma), can be placed at the same time as a diagnostic thoracoscopy, and is managed at home. Patient performance status, lung re-expansion capacity on imaging after drainage, and patient preference around daily home care all factor in.<ref name="ceruti_2018" />

== Quick Statistics ==

* '''>80%''' — proportion of pleural mesothelioma patients presenting with pleural effusion<ref name="bianco_2018" />
* '''~33%''' — cytology sensitivity for mesothelioma in the 2022 Pairman et al. cohort<ref name="pairman_2022" />
* '''~90%''' — cytology sensitivity for breast cancer in the same cohort (comparator)<ref name="pairman_2022" />
* '''~79%''' — cytology sensitivity for lung adenocarcinoma in the same cohort (comparator)<ref name="pairman_2022" />
* '''32%''' — Australian tertiary-center cytology yield for mesothelioma in the 2018 Loveland et al. cohort<ref name="loveland_2018" />
* '''87.9%''' — yield for other malignancies in the same Loveland cohort<ref name="loveland_2018" />
* '''>95%''' — VATS pleural biopsy diagnostic sensitivity (current standard)<ref name="bianco_2018" />
* '''Two independent risk factors''' — higher pleural fluid LDH and positive cytology, for effusion recurrence after drainage<ref name="grosu_2019" />

== Get Help ==

If you or a loved one was diagnosed with mesothelioma following the workup of a pleural effusion, compensation pathways exist and are time-sensitive.



* '''[https://dandell.com/ Danziger & De Llano]''' — free case evaluations for mesothelioma and asbestos-related lung disease; we file every applicable claim type (asbestos bankruptcy trust funds, civil personal injury and wrongful death lawsuits, VA disability claims for veterans) from a single intake. '''Call (855) 699-5441''' or visit [https://dandell.com/contact-us/ dandell.com/contact-us].
* '''[https://www.mesotheliomalawyercenter.org/mesothelioma/ Mesothelioma Lawyer Center]''' — patient and family resources on diagnosis, treatment, clinical trials, and legal options.
* '''[https://mesothelioma.net/ Mesothelioma.net]''' — comprehensive information on pleural mesothelioma diagnostic workup, treatment, and prognosis.



State statutes of limitations begin running at diagnosis. Trust fund claims have separate, shorter deadlines. Speaking with an experienced mesothelioma attorney early preserves every option.

== Related Pages ==

* [[Pleural_Mesothelioma]] — comprehensive overview of malignant pleural mesothelioma
* [[Mesothelioma_Diagnosis]] — the diagnostic workup beyond pleural effusion
* [[Mesothelioma_Staging]] — TNM staging once diagnosis is confirmed
* [[Pleurectomy_and_Decortication]] — lung-sparing surgical management
* [[HIPEC]] — peritoneal counterpart for peritoneal mesothelioma management
* [[Mesothelioma_Treatment]] — first-line systemic and surgical options

== References ==

<references>
<ref name="bianco_2018">Bianco A, Valente T, De Rimini ML, Sica G, Fiorelli A. Clinical diagnosis of malignant pleural mesothelioma. ''J Thorac Dis.'' 2018;10(Suppl 2):S253-S261. PMID 29507793. [https://pubmed.ncbi.nlm.nih.gov/29507793/ PubMed]</ref>
<ref name="kassirian_2023">Kassirian S, Hinton SN, Cuninghame S, Chaudhary R, Iansavitchene A, Amjadi K, Dhaliwal I, Zeman-Pocrnich C, Mitchell MA. Diagnostic sensitivity of pleural fluid cytology in malignant pleural effusions: systematic review and meta-analysis. ''Thorax.'' 2023;78(1):32-40. PMID 35110369. [https://pubmed.ncbi.nlm.nih.gov/35110369/ PubMed]</ref>
<ref name="pairman_2022">Pairman L, Beckert LEL, Dagger M, Maze MJ. Evaluation of pleural fluid cytology for the diagnosis of malignant pleural effusion: a retrospective cohort study. ''Intern Med J.'' 2022;52(7):1154-1159. PMID 35191191. [https://pubmed.ncbi.nlm.nih.gov/35191191/ PubMed]</ref>
<ref name="loveland_2018">Loveland P, Christie M, Hammerschlag G, Irving L, Steinfort D. Diagnostic yield of pleural fluid cytology in malignant effusions: an Australian tertiary centre experience. ''Intern Med J.'' 2018;48(11):1318-1324. PMID 29869427. [https://pubmed.ncbi.nlm.nih.gov/29869427/ PubMed]</ref>
<ref name="sterman_2005">Sterman DH, Albelda SM. Advances in the diagnosis, evaluation, and management of malignant pleural mesothelioma. ''Respirology.'' 2005;10(3):266-283. PMID 15955137. [https://pubmed.ncbi.nlm.nih.gov/15955137/ PubMed]</ref>
<ref name="davies_2009">Davies HE, Sadler RS, Bielsa S, Maskell NA, Rahman NM, Davies RJ, Ferry BL, Lee YC. Clinical impact and reliability of pleural fluid mesothelin in undiagnosed pleural effusions. ''Am J Respir Crit Care Med.'' 2009;180(5):437-444. PMID 19299498. [https://pubmed.ncbi.nlm.nih.gov/19299498/ PubMed]</ref>
<ref name="eccher_2021">Eccher A, Girolami I, Lucenteforte E, Troncone G, Scarpa A, Pantanowitz L. Diagnostic mesothelioma biomarkers in effusion cytology. ''Cancer Cytopathol.'' 2021;129(7):506-516. PMID 33465294. [https://pubmed.ncbi.nlm.nih.gov/33465294/ PubMed]</ref>
<ref name="mansour_2023">Mansour MSI, Huseinzade A, Seidal T, Hejny K, Maty A, Taheri-Eilagh F, Mager U, Dejmek A, Dobra K, Brunnström H. Comparison of immunohistochemical mesothelial biomarkers in paired biopsies and effusion cytology cell blocks from pleural mesothelioma. ''Cytopathology.'' 2023;34(5):456-465. PMID 37337638. [https://pubmed.ncbi.nlm.nih.gov/37337638/ PubMed]</ref>
<ref name="nabeshima_2022">Nabeshima K, Hamasaki M, Kinoshita Y, Matsumoto S, Sa-Ngiamwibool P. Update of pathological diagnosis of pleural mesothelioma using genomic-based morphological techniques, for both histological and cytological investigations. ''Pathol Int.'' 2022;72(8):389-401. PMID 35596704. [https://pubmed.ncbi.nlm.nih.gov/35596704/ PubMed]</ref>
<ref name="grosu_2019">Grosu HB, Molina S, Casal R, Song J, Li L, Diaz-Mendoza J, Reddy C, Yarmus L, Schiavo D, Simoff M, Johnstun J, Raid AA, Feller-Kopman D, Lee H, Sahetya S, Foley F, Maldonado F, Tian X, Noor L, Miller R, Mudambi L, Saettele T, Vial-Rodriguez M, Eapen GA, Ost DE. Risk factors for pleural effusion recurrence in patients with malignancy. ''Respirology.'' 2019;24(1):76-82. PMID 29966171. [https://pubmed.ncbi.nlm.nih.gov/29966171/ PubMed]</ref>
<ref name="ceruti_2018">Ceruti P, Lonni S, Baglivo F, Marchetti G. Endoscopic diagnosis and management of pleural effusion in malignant pleural mesothelioma. ''J Thorac Dis.'' 2018;10(Suppl 2):S269-S275. PMID 29507795. [https://pubmed.ncbi.nlm.nih.gov/29507795/ PubMed]</ref>
</references>

[[Category:Mesothelioma]]
[[Category:Medical]]
[[Category:Pleural Mesothelioma]]
[[Category:Diagnosis]]
[[Category:Symptoms and Signs]]
[[Category:Pleural Effusion]]
[[Category:Sprint 3c Baseline]]

Pleural Effusion - Revision history

MesotheliomaSupport: Phase 1 Session 1 baseline — 4 citation metadata fabs corrected vs PubMed efetch (Pairman/Maze, Mansour, Grosu, Ceruti); body-prose CTA stripped from ES per wiki-no-promo (CLEO #9185 dim-1=100, dim-2=100). Commits 865d5be + ab24c15.