The role and importance of pericardial effusions in the diagnosis of malignancy

Abstract

Objective: Pericardial effusion is a clinical condition characterized by the pathological accumulation of fluid within the pericardial cavity. It may develop secondary to cardiac, infectious, autoimmune, traumatic, or neoplastic processes. Malignancy-related effusions, particularly in patients with advanced-stage cancer, may cause significant morbidity and mortality. Cytological examination of pericardial fluid is an effective and minimally invasive diagnostic method for differentiating malignant from benign etiologies. In this study, it was aimed to retrospectively evaluate the cytological findings of pericardial effusion samples obtained by pericardiocentesis and to determine the malignancy rate.Method: This retrospective study included 26 patients who underwent pericardiocentesis at the Cardiology Clinic of Sivas Cumhuriyet University between January 2019 and September 2022. Cytological smears were stained with Papanicolaou and Giemsa methods. The cases were categorized as benign/reactive, malignant, suspicious for malignancy, or non-diagnostic. When necessary, cell blocks were prepared, and immunohistochemical analyses using markers such as TTF-1 and GATA-3 were performed.Results: The mean age of the patients was 58.5 years; 17 (65.4%) were female and 9 (34.6%) were male. Cytological evaluation revealed 13 (50%) benign/reactive, 6 (23%) malignant, 6 (23%) suspicious for malignancy, and 1 (4%) non-diagnostic cases. All malignant effusions were metastatic in origin, most frequently lung adenocarcinoma, followed by breast carcinoma and lymphoma.Conclusion: Pericardial fluid cytology is an effective method for detecting malignancy in patients with pericardial effusion. Cell block and immunohistochemical analyses improved diagnostic accuracy. Despite the study’s limited sample size, the findings underscore the importance of cytological evaluation in guiding the diagnosis and management of pericardial effusions.