Analysis of pleural amylase levels in a chest disease clinic

Year 2013, Volume: 30 Issue: 4, 349 - 352, 05.02.2014

Suna Türkeli Atilla Atıcı , Servet Kayhan Yasemin Yılmaz

Abstract

The aim of this study was to evaluate whether pleural amylase levels in pleural fluid had a diagnostic value for discriminating the reasons of pleural effusions. Totally 115 patients with pleural effusion were enrolled in this prospective study. Pleural fluids and serum samples were obtained from all of the patients and analyzed for transudate or exudate classification and other biochemical analysis. Amylase levels were measured in vitro by Roche/Hitachi cobas-c systems in biochemical laboratory. Of the patients, 76 (66%) were male and 39 (34%) of them were female. The mean age was 62.2±15.3 and the range of age was between 20 and 94 years. Of the pleural fluids, 26 (22.6%) were determined as transudate and 89 (77.4%) were as exudate. As a common reason of pleural effusions, 16 (61.5%) of the transudates were originated from heart failure and 29 (32.5%) of the exudates were originated from lung cancer. The ratio between the serum amylase level and pleural fluid amylase level was not different statistically in the aspect of all transudates and exudates caused by tumors or any other situations. Seven (6.1%) of pleural effusions were amylase rich and 4 of them were tumoral origin, the other 3 of them caused by extratumoral causes. Amylase rich pleural fluids were determined more frequently in malignant effusions than paramalignant effusions in the present study (p=0.028). As a conclusion, high pleural amylase levels are associated with a variety of benign and malign etiologies and the adenocarcinoma type of lung cancer is predominant reason.

J. Exp. Clin. Med., 2013; 30:349-352

Keywords

Amylase; exudate; pleural effusions; transudate

References

• Branca, P., Rodriguez, R.M., Rogers, J.T., Ayo, D.S., Moyers, J.P., Light, R.W., 2001. Routine measurement of pleural fluid amylase is not indicated. Arch. Intern. Med. 161, 228-232.
• Cramer, S.F., Bruns, D.E., 1979. Amylase-producing ovarian neoplasm with pseudo-Meigs’ syndrome and elevated pleural fluid amylase: Case report and ultrastructure. Cancer. 44, 1715-1721.
• Devuyst, O., Lambert, M., Scheiff, J.M., Francart, J. 1990. High amylase activity in pleural fluid and primary bronchogenic adenocarcinoma. Eur. Respir. J. 3, 1217-1220.
• Foresti, V., Villa, A., Zubani, R. 1994. Amylase concentrations in pleural effusions. Chest. 105, 1625-1626.
• Gupta, K.B., Ghalaut, V., Gupta, R., Tandon, S., Prakash, P., 2001. Estimation and serum of pleural fluid amylase and iso-enzyme in cases of malignant pleural effusions. Ind. J. Tub. 48, 87.
• Hooper, C., Lee Y.C., Maskell, N., 2010. BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 65, 4-17.
• Joseph, J., Viney, S., Beck, P., Strange, C., Sahn, S.A., Basran, G.S., 1992. A prospective study of amylase-rich pleural effusions with special reference to amylase isoenzyme analysis. Chest. 102, 1455-1459.
• Kinasewitz, G.T., 1998. Pleural fluid dynamics and effusions. In: Fishman AP (Ed). Fishman’s Pulmonary Diseases and Disorders. New York: Mc Graw-Hill Book Company, pp. 1389-1409.
• Kramer, M.R., Saldana, M.J., Cepero, R.J., Pitchenik, A.E., 1989. High amylase levels in neoplasm-related pleural effusion. Ann. Intern. Med. 110, 567-569.
• Light, R.W. 2007. Clinical manifestations and usefull tests In: Light RW (Ed). Pleural Diseases. 5th ed. Philadelphia, Lippincott Williams & Wilkins, pp. 73-100.
• McKenna, J.M., Chandrasekhar, A.J., Skorton, D., Craig, R.M., Cugell, D.W., 1977. The pleuropulmonary complications of pancreatitis. Clinical conference in pulmonary disease from Northwestern University-McGaw Medical Center and Veterans Administration Lakeside Hospital, Chicago. Chest. 71, 197-204.
• Salt, W.B., Schenker, S., 1976. Amylase-its clinical significance: A review of the literature. Medicine. 55, 269-289. Shapiro, R., Dropkin, R., Finkelstein, J., Aledort, D., Greenstein, A.J., 1981. Ovarian carcinomatosis presenting with hyperamylasemia and pleural effusion. Am. J. Gastroenterol. 76, 365-368.
• Villena, V., Perez, V., Pozo, F., Lopez-Encuentra, A., Echave-Sustaeta, J., Arenas, J., Escribano, P.M., 2002. Amylase levels in pleural effusions: A consecutive unselected series of 841 patients. Chest. 121, 470-474.