Advances in pleural infection and malignancy

Bedawi, Eihab; Guinde, Julien; Rahman, Najib M.; Astoul, Philippe

doi:10.1183/16000617.0002-2020

Cited by 15 publications

(17 citation statements)

References 128 publications

(138 reference statements)

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“…PE is a common clinical manifestation caused by more than 50 diseases. Tuberculosis, pneumonia, and malignancy are among the most common causes of PE ( 2 , 3 , 11 ). In recent years, patients with BPE, such as TPE and PPE, can be clinically cured due to advances in treatment regimens and early diagnosis ( 2 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

“…Tuberculosis, pneumonia, and malignancy are among the most common causes of PE ( 2 , 3 , 11 ). In recent years, patients with BPE, such as TPE and PPE, can be clinically cured due to advances in treatment regimens and early diagnosis ( 2 , 22 ). Conversely, MPE usually indicates advanced malignant diseases related to heavy healthcare burden and a high mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…Pleural effusion (PE) is a common clinical problem resulting from increased fluid in the pleural cavity ( 1 , 2 ). The various etiologies of PE can be divided into benign pleural effusion (BPE) and malignant pleural effusion (MPE) ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…In China, the majority of BPE arises from tuberculous pleural effusion (TPE), parapneumonic effusion (PPE), and heart failure (HF) ( 4 ). With regard to MPE, lung cancer, breast cancer, and lymphomas account for over 75% of MPE cases ( 1 , 2 , 5 ). The presence of MPE indicates systemic cancer dissemination and a reduction of life expectancy and quality in patients ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

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Development and Validation of a Scoring System for Early Diagnosis of Malignant Pleural Effusion Based on a Nomogram

Liang

Yuan

et al. 2021

Front. Oncol.

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BackgroundThe diagnostic value of clinical and laboratory features to differentiate between malignant pleural effusion (MPE) and benign pleural effusion (BPE) has not yet been established.ObjectivesThe present study aimed to develop and validate the diagnostic accuracy of a scoring system based on a nomogram to distinguish MPE from BPE.MethodsA total of 1,239 eligible patients with PE were recruited in this study and randomly divided into a training set and an internal validation set at a ratio of 7:3. Logistic regression analysis was performed in the training set, and a nomogram was developed using selected predictors. The diagnostic accuracy of an innovative scoring system based on the nomogram was established and validated in the training, internal validation, and external validation sets (n = 217). The discriminatory power and the calibration and clinical values of the prediction model were evaluated.ResultsSeven variables [effusion carcinoembryonic antigen (CEA), effusion adenosine deaminase (ADA), erythrocyte sedimentation rate (ESR), PE/serum CEA ratio (CEA ratio), effusion carbohydrate antigen 19-9 (CA19-9), effusion cytokeratin 19 fragment (CYFRA 21-1), and serum lactate dehydrogenase (LDH)/effusion ADA ratio (cancer ratio, CR)] were validated and used to develop a nomogram. The prediction model showed both good discrimination and calibration capabilities for all sets. A scoring system was established based on the nomogram scores to distinguish MPE from BPE. The scoring system showed favorable diagnostic performance in the training set [area under the curve (AUC) = 0.955, 95% confidence interval (CI) = 0.942–0.968], the internal validation set (AUC = 0.952, 95% CI = 0.932–0.973), and the external validation set (AUC = 0.973, 95% CI = 0.956–0.990). In addition, the scoring system achieved satisfactory discriminative abilities at separating lung cancer-associated MPE from tuberculous pleurisy effusion (TPE) in the combined training and validation sets.ConclusionsThe present study developed and validated a scoring system based on seven parameters. The scoring system exhibited a reliable diagnostic performance in distinguishing MPE from BPE and might guide clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development and Validation of a Scoring System for Early Diagnosis of Malignant Pleural Effusion Based on a Nomogram

Liang

Yuan

et al. 2021

Front. Oncol.

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“…PACT study has been designed to introduce ambulatory management strategies for pleural infections. One of the workstreams is focused on studying the effectiveness of antibiotics’ ability to penetrate pleural space which will facilitate de-escalation of antibiotics, hence assisting in antibiotic stewardship and reducing the emergence of resistant organisms [ 30 ].…”

Section: Reviewmentioning

confidence: 99%

From Chest Wall Resection to Medical Management: The Continued Saga of Parapneumonic Effusion Management and Future Directions

Santoshi¹,

Chandar²,

Gupta

et al. 2022

Cureus

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Pleural space infections have been described since the time of Hippocrates and to this day remains a significant pathology. Every year in the USA approximately there are one million hospital admissions for pneumonia with 20%-40% associated with some form of pleural space infections leading to pleural effusions with increased morbidity and mortality. Often, management of these effusions mandate combination of medical treatment and surgical drainage with debridement and decortication. There has been a lot of ongoing research regarding the safety and efficacy of intrapleural fibrinolytics in the management of complicated pleural effusions and empyema. Till this day, areas of debate and controversies exist among clinicians treating pleural space infection. Empyema is historically considered a surgical disease. There have been societies and guidelines for the management of infected parapneumonic effusions with antibiotics and chest tube drainage as an initial empiric treatment modality. With the advances in the use of Intrapleural fibrinolytics and minimally invasive procedures such as video-assisted thoracoscopic surgery (VATS), empyema a surgical disease is now more favoring medical management. Surgical option, such as open thoracotomy, is reserved for patients who failed conservative management and chronic empyema. The aim of this comprehensive review is to shed light on the evolution of various management strategies from the era of Hippocrates to current day practice and how there continues to be a paradigm shift in treating empyema as a surgical condition to a medical disease.

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Empyema Thoracis

Shore

Toth

2023

Interventions in Pulmonary Medicine

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Advances in pleural infection and malignancy

Cited by 15 publications

References 128 publications

Development and Validation of a Scoring System for Early Diagnosis of Malignant Pleural Effusion Based on a Nomogram

Development and Validation of a Scoring System for Early Diagnosis of Malignant Pleural Effusion Based on a Nomogram

From Chest Wall Resection to Medical Management: The Continued Saga of Parapneumonic Effusion Management and Future Directions

Empyema Thoracis

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