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The value of the new scoring system for predicting neoplastic pericarditis in the patients with large pericardial effusion

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Abstract

Purpose

Early recognition of neoplastic pericarditis (npe) is crucial for the planning of subsequent therapy. The aim of the present study was to construct the scoring system assessing the probability of npe, in the patients requiring pericardial fluid (pf) drainage due to large pericardial effusion.

Methods

One hundred forty-six patients, 74 males and 72 females, entered the study. Npe based on positive pf cytology and/or pericardial biopsy specimen was recognised in 66 patients, non-npe in 80. Original scoring system was constructed based on parameters with the highest diagnostic value: mediastinal lymphadenopathy on chest CT scan, increased concentration of tumour markers (cytokeratin 19 fragments—Cyfra 21-1 and carcinoembryonic antigen—CEA) in pf, bloody character of pf, signs of imminent cardiac tamponade on echocardiography and tachycardia exceeding 90 beats/min on ECG. Each parameter was scored with positive or negative points depending on the positive and negative predictive values (PPV, NPV).

Results

The area under curve (AUC) for the scoring system was 0.926 (95%CI 0.852–0.963) and it was higher than AUC for Cyfra 21-1 0.789 (95%CI 0.684–0.893) or CEA 0.758 (95%CI 0.652–0.864). The score optimally discriminating between npe and non-npe was 0 points (sensitivity 0.84, specificity 0.91, PPV 0.9, NPV 0.85).

Conclusion

Despite chest CT and tumour marker evaluation in pericardial fluid were good discriminators between npe and non-npe, the applied scoring system further improved the predicting of neoplastic disease in the studied population.

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Author information

Authors and Affiliations

  1. 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland

    M. Szturmowicz

  2. Independent Centre of Public Outpatient Care Units, Warsaw, Poland

    A. Pawlak-Cieślik

  3. Department of Cardiology National Research Institute for Mother and Child, Warsaw, Poland

    A. Fijałkowska

  4. Department of Thoracic Surgery, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland

    J. Gątarek

  5. Freelance Statistical Analytic, Warsaw, Poland

    A. Skoczylas

  6. Cardiopulmonary Intensive Care Unit, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland

    M. Dybowska & W. Tomkowski

  7. Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland

    K. Błasińska-Przerwa

  8. Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland

    R. Langfort

Authors
  1. M. Szturmowicz
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  2. A. Pawlak-Cieślik
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  3. A. Fijałkowska
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  4. J. Gątarek
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  5. A. Skoczylas
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  6. M. Dybowska
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  7. K. Błasińska-Przerwa
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  8. R. Langfort
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  9. W. Tomkowski
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Corresponding author

Correspondence to M. Szturmowicz.

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Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. The written consent of agreement for all diagnostic procedures was obtained from every patient.

Source of funding

This study was supported by the National Tuberculosis and Lung Diseases Research Institute, project no 3.10.

Conflict of interest

The authors declare that they have no conflict of interest.

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Szturmowicz, M., Pawlak-Cieślik, A., Fijałkowska, A. et al. The value of the new scoring system for predicting neoplastic pericarditis in the patients with large pericardial effusion. Support Care Cancer 25, 2399–2403 (2017). https://doi.org/10.1007/s00520-017-3645-4

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  • DOI: https://doi.org/10.1007/s00520-017-3645-4

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