Current and future options for the diagnosis of malignant pleural effusion

Abstract

Ultrasound techniques will stay as valuable tools for pleural effusions. Biomarkers in pleural fluid do not currently provide an acceptable yield for MPE. In subjects with past history of asbestos exposure, some serum or plasma markers (soluble mesothelin, fibulin) might help in selecting cases for close follow-up, to detect mesothelioma early. Needle pleural biopsy is justified only if used with image-techniques (ultrasound or CT) guidance, and thoracoscopy is better for both diagnosis and immediate palliative treatment (pleurodesis). Animal models of MPE and 'spheroids' are promising for research involving both pathophysiology and therapy. Considering the possibility of direct pleural delivery of nanotechnology-developed compounds-fit to both diagnosis and therapy purposes ('theranostics')-MPE and mesothelioma in particular are likely to benefit sooner than later from this exciting perspective.

Microbiome profile associated with malignant pleural effusion

“…[1,2] A majority of these effusions are secondary to metastatic involvement of the pleura from lung cancer and breast cancer. [2][3][4] However, at a fundamental level, our knowledge for the molecular pathogenesis of initiation and progression of MPE remains poor. There is ongoing research into the development of novel molecular markers that may complement fluid cytology in the diagnosis of malignant pleural effusion (MPE).…”

“…[1] Conventional pleural fluid cytology on first thoracentesis are positive in only 50% of cases. [2] When the diagnosis is not obtained, repeat thoracentesis and cytological examination merely confers a small additive diagnostic value and more invasive procedures such as thoracoscopic pleural biopsy are required. [3,4] Investigations have identified associations between specific microbes and different cancers.…”

"Dry" Pleural Mesothelioma Successfully Diagnosed on Endobronchial Ultrasound (EBUS)-guided Transbronchial Needle Aspiration (TBNA)

“…The definitive diagnosis is commonly made on a histological examination of pleural biopsy specimens obtained via invasive procedures (surgical or medical thoracoscopy) (4). Indeed, the role of mini-invasive techniques (percutaneous or endoscopic procedures) in such patients is limited and remains controversial, even considering the need for "large" and "deep" specimens to achieve a definitive diagnosis.…”

“…Indeed, the role of mini-invasive techniques (percutaneous or endoscopic procedures) in such patients is limited and remains controversial, even considering the need for "large" and "deep" specimens to achieve a definitive diagnosis. In such cases, the echoendoscopic approach (transbronchial or transesophageal) has only been attempted very rarely (3)(4)(5)(6) and is usually reserved for cases in which mediastinal lymph node involvement is detected.…”

Προκλινική Δοκιμασία Θεραπευτικής Αναστολής Των Χημειοκινών McP-1/5 Σε Πρότυπο Κακοήθους Υπεζωκοτικής Συλλογής Ποντικών

“…Από τα σχετιζόμενα με τα στόματα λεμφικά κανάλια, σχηματίζονται λεμφικά «κενά» ακριβώς κάτω από τη στιβάδα των μεσοθηλιακών κυττάρων, από τα οποία ξεκινούν τα λεμφαγγεία με κατεύθυνση τους μεσοθωρακικούς κυρίως λεμφαδένες. Πέραν όμως από τη διαταραχή της αποχέτευσης του υπεζωκοτικού υγρού στο επίπεδο των στομάτων, κακοήθης πλευριτική συλλογή μπορεί να σχηματιστεί εφόσον υπάρχει απόφραξη σε οποιοδήποτε σημείο της τοπικής λεμφικής απαγωγού οδού, όπως στο επίπεδο των ενδοπνευμονικών, πυλαίων ή και μεσοθωρακικών λεμφαδένων, μηχανισμός στον οποίο πρωτοαναφέρθηκε το 1966 ο Meyer (Meyer, 1966) (Sahn, 2008) (Rodriguez-Panadero, 2008 (Rodriguez-Panadero & Romero-Romero, 2013).…”