The role of cytology in the evaluation of pericardial effusions.

Pericardial effusions from 47 patients were examined for cancer cells. Fluids from 13 of the 15 patients with neoplasm involving the pericardium were decisively "positive." There were no false positive reports. Three patients had malignancy localized to the chest, but not metastatic to the pericardium. Ef-fusions from these three patients contained no tumor cells. The accumulation of fluid in a patient with a known or suspected malignancy does not necessarily mean metastatic disease. Cytologic evaluation of these fluids is helpful in establishing a prognosis and mode of therapy. r T , he presence of effusions in body cavities can be a confusing clinical problem in differential diagnosis. The examination of pleural and peritoneal fluids by cytologic methods has already proved to be of decisive value in the diagnosis of malignant, as well as non-malignant disease. 1 " 8 Surveys of the possibilities and limitations of peri-cardial fluid cytology have been limited, probably because pericardial fluids constitute less than 1 percent of the serous fluids examined in a cytology laboratory. The purpose of this paper is to show that the cytologic examination of pericardial fluids may play a significant role in the differential diagnosis of pericardial effusions. Each year at Duke Hospital, 25-30 pericardiocenteses are performed. In two-thirds of these, the pericardial effusions are of known etiology, usually uremic pericarditis. In eight to ten patients per year, however, the etiologies of the effusions arc not certain, and samples of the fluid are submitted to the eytopathology laboratory for evaluation. In recent years, 70 pericardial fluid specimens have been examined in the eytopathology laboratory at the Duke University Medical Center. Tn 47 of these patients sufficient histologic or clinical information was available to leave no doubt about the absence or presence of a neoplasm involving the pericardium. Fifteen of the 47 cases had histopathologic confirmation (by open pericardial biopsy or autopsy examination) of a neoplasm involving the pericardium. The absence of pericardial neoplasm in the other 32 cases included in the study was confirmed by histopathologic examination or by adequate clinical followup. Until 1966, the pericardial fluids were mixed with equal parts of 10 percent formalin prior to being brought to the cytology laboratory. These specimens were centrifuged, and smears and cell blocks were prepared from the sediment. Since 1966, the fluids have been heparinized, (1-3 units of heparin per ml of effusion) at the time of pericardiocenteses and submitted immediately and …