Diagnosis and Management of Malignant Pleural Effusion: A Decade in Review

Jacobs, Blake; Sheikh, Ghias; Youness, Houssein; Keddissi, Jean I.; Abdo, Tony

doi:10.3390/diagnostics12041016

Cited by 18 publications

(13 citation statements)

References 113 publications

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“…In some cases, fluid accumulation can be severe and difficult to manage, leading to an intractable pleural effusion [ 9 ]. Although conservative measures such as thoracentesis and chest tube drainage can be effective in managing pleural effusion, as demonstrated in this case, some patients may require more invasive interventions such as surgical pleurodesis to achieve long-term symptom resolution [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Intractable Pleural Effusion After Stereotactic Ablative Radiotherapy for Early-Stage Lung Cancer

Katano¹,

Minamitani²,

Nozawa³

et al. 2023

Cureus

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Stereotactic ablative radiotherapy (SABR) is an effective and attractive treatment option for patients who are poor surgical candidates. This case report describes a rare but serious complication of intractable pleural effusion after SABR for early-stage lung cancer. The patient was an 89-year-old woman with a medical history of early-stage breast cancer who was treated with partial resection and postoperative radiotherapy of 50 gray (Gy) in 25 fractions. SABR using 55 Gy in four fractions was conducted for lung lesions. The patient developed a pleural effusion that was refractory to conservative management and required multiple interventions, including repeated thoracentesis. This case report emphasizes the importance of monitoring and managing pleural effusion in patients with lung cancer receiving radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Intractable Pleural Effusion After Stereotactic Ablative Radiotherapy for Early-Stage Lung Cancer

Katano¹,

Minamitani²,

Nozawa³

et al. 2023

Cureus

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“…Dazu zählen z.B. eine Pleuraverdickung (>1 cm), eine Zwerchfellverdickung (>7 mm) und eine Pleuraknötchenbildung [2]. Die Computertomographie (CT) des Thorax stellt eine weitere Untersuchung dar, die im Rahmen der diagnostischen Abklärung eines unklaren Pleuraergusses einen sehr hohen Stellenwert hat und bei allen Patienten mit Verdacht auf ein Malignom indiziert ist [2].…”

Section: Transfer In Die Praxis Von Dr Stefanie Keymel (Düsseldorf)unclassified

“…eine Pleuraverdickung (>1 cm), eine Zwerchfellverdickung (>7 mm) und eine Pleuraknötchenbildung [2]. Die Computertomographie (CT) des Thorax stellt eine weitere Untersuchung dar, die im Rahmen der diagnostischen Abklärung eines unklaren Pleuraergusses einen sehr hohen Stellenwert hat und bei allen Patienten mit Verdacht auf ein Malignom indiziert ist [2]. Bleibt der Erguss nach der klinischen Beurteilung, den Resultaten der Thorakozentese und den bildgebenden Verfahren nicht eindeutig geklärt, ist eine histologische Sicherung mittels transthorakaler Pleurabiopsie oder Thorakoskopie indiziert.…”

Section: Transfer In Die Praxis Von Dr Stefanie Keymel (Düsseldorf)unclassified

Pleurakarzinose: Können wir uns in der Diagnostik auf die Computertomographie verlassen?

Keymel¹

2023

Kompass Pneumol

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Background: Pleural malignancy (PM) and malignant pleural effusion (MPE) represent an increasing burden of diseases. Costo-phrenic angle (CPA) could be involved by malignant small nodularities or thickenings in the case of MPE. The aim of this study was to evaluate whether lung ultrasound (LUS), performed prior to medical thoracoscopy (MT), could detect pleural abnormalities in CPA not easily detectable by chest computed tomography scan (CCT). Methods: Patients suspected for PM and MPE were retrospectively recruited. Patients underwent both LUS examination with a linear array and CCT prior to diagnostic medical thoracoscopy. LUS pathological findings in CPA were compared with pathological findings detected by CCT. Findings were confirmed by subsequent MT, the gold standard for PMs. Results: Twenty-eight patients were recruited. LUS detected 23 cases of pleural abnormalities in CPA. CCT was detected 12 pleural abnormalities. Inter-rater agreement between the two techniques was minimal (Cohen’s Kappa: 0.28). MT detected PMs in CPA in 22 patients. LUS had a sensitivity of 100% and specificity of 83%. CCT had a sensitivity of 54% and specificity of 100%. A better sensitivity for CCT was reached analysing only all abnormalities > 5 mm (64.3%). Conclusions: LUS examination, in the case of PMs, could change and speed up diagnostic workup.

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“…Patients have a median survival of only 4−7 months from the time of diagnosis and usually suffer from severe respiratory distress due to the presence and recurrence of MPE 3–5 . Removing fluid and preventing its accumulation is presently the main strategy for the management of MPE 6,7 . Among patients with non‐small‐cell lung cancer (NSCLC), the initiation of MPE usually marks the advanced disease stage, occurring in more than 15% of patients during the course of the disease.…”

Section: Introductionmentioning

confidence: 99%

Single‐cell transcriptomics reveal metastatic CLDN4+ cancer cells underlying the recurrence of malignant pleural effusion in patients with advanced non‐small‐cell lung cancer

Zhang,

Wang,

Wen

et al. 2024

Clinical & Translational Med

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BackgroundRecurrent malignant pleural effusion (MPE) resulting from non‐small‐cell lung cancer (NSCLC) is easily refractory to conventional therapeutics and lacks predictive markers. The cellular or genetic signatures of recurrent MPE still remain largely uncertain.Methods16 NSCLC patients with pleural effusions were recruited, followed by corresponding treatments based on primary tumours. Non‐recurrent or recurrent MPE was determined after 3–6 weeks of treatments. The status of MPE was verified by computer tomography (CT) and cytopathology, and the baseline pleural fluids were collected for single‐cell RNA sequencing (scRNA‐seq). Samples were then integrated and profiled. Cellular communications and trajectories were inferred by bioinformatic algorithms. Comparative analysis was conducted and the results were further validated by quantitative polymerase chain reaction (qPCR) in a larger MPE cohort from the authors' centre (n = 64).ResultsThe scRNA‐seq revealed that 33 590 cells were annotated as 7 major cell types and further characterized into 14 cell clusters precisely. The cell cluster C1, classified as Epithelial Cell Adhesion Molecule (EpCAM)+ metastatic cancer cell and correlated with activation of tight junction and adherence junction, was significantly enriched in the recurrent MPE group, in which Claudin‐4 (CLDN4) was identified. The subset cell cluster C3 of C1, which was enriched in recurrent MPE and demonstrated a phenotype of ameboidal‐type cell migration, also showed a markedly higher expression of CLDN4. Meanwhile, the expression of CLDN4 was positively correlated with E74 Like ETS Transcription Factor 3 (ELF3), EpCAM and Tumour Associated Calcium Signal Transducer 2 (TACSTD2), independent of driver‐gene status. CLDN4 was also found to be associated with the expression of Hypoxia Inducible Factor 1 Subunit Alpha (HIF1A) and Vascular Endothelial Growth Factor A (VEGFA), and the cell cluster C1 was the major mediator in cellular communication of VEGFA signalling. In the extensive MPE cohort, a notably increased expression of CLDN4 in cells from pleural effusion among patients diagnosed with recurrent MPE was observed, compared with the non‐recurrent group, which was also associated with a trend towards worse overall survival (OS).ConclusionsCLDN4 could be considered as a predictive marker of recurrent MPE among patients with advanced NSCLC. Further validation for its clinical value in cohorts with larger sample size and in‐depth mechanism studies on its biological function are warranted.Trial registrationNot applicable.

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Diagnosis and Management of Malignant Pleural Effusion: A Decade in Review

Cited by 18 publications

References 113 publications

Intractable Pleural Effusion After Stereotactic Ablative Radiotherapy for Early-Stage Lung Cancer

Intractable Pleural Effusion After Stereotactic Ablative Radiotherapy for Early-Stage Lung Cancer

Pleurakarzinose: Können wir uns in der Diagnostik auf die Computertomographie verlassen?

Single‐cell transcriptomics reveal metastatic CLDN4+ cancer cells underlying the recurrence of malignant pleural effusion in patients with advanced non‐small‐cell lung cancer

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