Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial

Muruganandan, Sanjeevan; Azzopardi, Maree; Fitzgerald, Deirdre; Shrestha, Rabindra Man; Kwan, Benjamin; Lam, David; Chaneet, Christian C De; Ali, Muhammad Redzwan S. Rashid; Yap, Elaine; Tobin, Claire; Garske, Luke; Nguyen, Phan; Stanley, Christopher; Popowicz, Natalia; Kosky, Christopher; Thomas, Rajesh; Read, Catherine; Budgeon, Charley; Feller‐Kopman, David; Maskell, Nick A; Murray, Kevin; Lee, Y C Gary

doi:10.1016/s2213-2600(18)30288-1

Cited by 165 publications

(129 citation statements)

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“…Very often, the lung may appear non‐expandable immediately after evacuation of MPE but will expand fully over a few days, especially if the effusion has accumulated over a long period of time. In the Australasian Malignant PLeural Effusion trial‐2, patients with NEL could develop autopleurodesis especially if drained daily via an indwelling pleural catheter (IPC). Clinicians must also discard the old belief that patients with NEL will not derive symptom benefits from fluid drainage (reviewed elsewhere) …”

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confidence: 99%

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Expanding knowledge on non‐expandable lungs

Lee

2019

Respirology

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confidence: 99%

“…Martin et al 2 defined NEL as apposition of the lung to <50% of the lateral chest wall on chest radiographs (CXR), although other studies used more stringent cut-off values (<25%). 7 NEL from malignant causes are often not uniformly trapped. Two-dimensional images (e.g.…”

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confidence: 99%

Expanding knowledge on non‐expandable lungs

Lee

2019

Respirology

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“…However, this statement was not designed to be a precise diagnostic criterion for NEL and other studies have used alternatives (e.g. <75% pleural apposition) . A different definition of NEL might improve inter‐observer variability, but may be less clinically relevant as subtle NEL might still be amenable to a pleurodesis attempt.…”

Section: Discussionmentioning

confidence: 99%

“…<75% pleural apposition). 3,11,12 A different definition of NEL might improve inter-observer variability, but may be less clinically relevant as subtle NEL might still be amenable to a pleurodesis attempt.…”

Section: Discussionmentioning

confidence: 99%

Inter‐observer variation in image interpretation and the prognostic importance of non‐expansile lung in malignant pleural effusion

et al. 2019

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Background and objective Non‐expansile lung (NEL) frequently complicates management of malignant pleural effusion (MPE) and is an important factor in clinical practice and trials. NEL is frequently diagnosed on a single radiographic observation, but neither the inter‐observer agreement of this approach nor the prognostic importance of NEL in MPE has been reported. Methods A multicentre retrospective cohort study was performed in two UK pleural centres. NEL was defined as <50% pleural re‐apposition on post‐drainage radiographs by primary and secondary assessors at each site. Inter‐observer agreement was assessed by Cohen's kappa (κ). Kaplan–Meier methodology and multivariate Cox models were used to assess the prognostic impact of NEL versus no NEL and ‘complete NEL’ versus ‘complete expansion’, based on a single assessor's results from each site. Results NEL was identified by the primary assessor in 33 of 97 (34%) in Cohort 1 and 15 of 86 (17%) in Cohort 2. Inter‐observer agreement between assessors was only fair‐to‐moderate (Cohort 1 κ: 0.38 (95% CI: 0.21–0.55), Cohort 2 κ: 0.51 (95% CI: 0.30–0.72)). In both cohorts, NEL was associated with shorter median overall survival (Cohort 1: 188 vs 371 days, Cohort 2: 192 vs 412 days). This prognostic association was independent in Cohort 1 (hazard ratio (HR): 2.19, 95% CI: 1.31–3.66) but not in Cohort 2 (HR: 1.42, 95% CI: 0.71–2.87). Survival was inferior in both cohorts in cases of complete NEL versus complete expansion. Conclusion Radiographic NEL is common but inter‐observer agreement is only fair‐to‐moderate. NEL is associated with adverse survival. These data do not support the use of single radiographic assessments to classify NEL.

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“…The AMPLE (Australasian Malignant PLeural Effusion) RCT found that IPC, compared to talc pleurodesis, significantly reduces number of days MPE patients spent in hospital in their remaining life as well as need of further invasive pleural procedures . Both the ASAP and AMPLE‐2 RCTs showed that daily drainage after IPC insertion promotes spontaneous pleurodesis and likelihood of catheter removal . Complications associated with IPC use are generally acceptable .…”

Section: Acknowledgementsmentioning

confidence: 99%