Malignant Pleural Effusions: Updates in Diagnosis and Management

Hughes, Stephen; Carmichael, Jacob Jonas

doi:10.3390/life13010115

Cited by 4 publications

(6 citation statements)

References 56 publications

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“…(Table - In the case of lung cancer, approximately 50% of patients will experience having an MPE at some point during their treatment, with 15% developing an effusion at the time of diagnosis. 10 During MPE development, tumor cells reach the pleural space via hematogenous, direct, or lymphatic dissemination. Fluid accumulation in the pleural space can be caused by tumor development that obstructs lymphatic outflow.…”

Section: Resultsmentioning

confidence: 99%

Short comparison of talc poudrage and tetracycline pleurodesis within patients suffering from malignant pleural effusion.

Zeeshan Ashraf,

Muhammad Ashraf

2023

TPMJ

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Objective: To compare talc poudrage and tetracycline pleurodesis within patients suffering from malignant pleural effusion. Study Design: Controlled Clinical Trial. Setting: Division of Pulmonology, Jinnah Hospital Lahore. Period: September, 2022 up until May, 2023. Material & Methods: 100 individuals, both male and female, ranging in age from 20 to 80 years, diagnosed with malignant pleural effusion confirmed on biopsy were included by nonprobability consecutive sampling. Patients with active pleural infection, hemodynamic instability, systemic infection, serum hematocrit < 25%, hemothorax, chylothorax, multiple etiologies of pleural effusion, prior chemical pleurodesis, sensitivity to study drugs, life expectancy < 1 month, pregnancy and chest X-ray displaying trapped lung post chest tube drainage on the affected side were excluded. The patients were allocated into two groups at random using a lottery system. In group 1, patients received pleurodesis with talc poudrage and in group 2, patients received pleurodesis alongside tetracycline. Success was assessed after 4 weeks of pleurodesis. Results: In this study, mean age in talc group was 58.94±13.6 years and in tetracycline group it was 59.26±13.7 years.65% patients were male and 35% were females.Success was 94% in talc group and 76% in tetracycline group with p-value = 0.012. In terms of adverse effects, there is no statistically significant difference between the two groups. Conclusion: Talc pleurodesis has a higher success rate than the tetracycline pleurodesis. Talc pleurodesis also has less adverse effects than tetracycline pleurodesis.

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Section: Resultsmentioning

confidence: 99%

Short comparison of talc poudrage and tetracycline pleurodesis within patients suffering from malignant pleural effusion.

Zeeshan Ashraf,

Muhammad Ashraf

2023

TPMJ

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“…In addition, previous studies also regarded patients with recurrent MPE as those experiencing at least one additional pleural procedure after the first thoracentesis and their pleural effusion was confirmed malignant 31,32 . Also, in the diagnosis of MPE, CT appears to add additional value, with improved characterization of pleural nodularity, diaphragmatic thickening, and evidence of metastatic disease in the lung, abdomen, and chest wall, which can further stratify risk and aid in diagnosis 33 . Overall, in our study, after one treatment cycle with approximately 3−4 weeks, CT was used again to evaluate the treatment effect on pleural effusion for each patient.…”

Section: Methodsmentioning

confidence: 99%

“… 31 , 32 Also, in the diagnosis of MPE, CT appears to add additional value, with improved characterization of pleural nodularity, diaphragmatic thickening, and evidence of metastatic disease in the lung, abdomen, and chest wall, which can further stratify risk and aid in diagnosis. 33 Overall, in our study, after one treatment cycle with approximately 3−4 weeks, CT was used again to evaluate the treatment effect on pleural effusion for each patient. During the process, no additional pleural procedures were conducted.…”

Section: Methodsmentioning

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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“…Other symptoms of malignant pleural mesothelioma (MPM) include fatigue, loss of appetite, weight loss, sweating, and pain. Cytokines are produced by the tumor and the host in response to cytokines in the blood ( 62 ). There is a lower incidence of bronchial tumor-related symptoms, such as cough, hemoptysis, and lymphadenopathy, in MPM.…”

Section: Symptomsmentioning

confidence: 99%

Malignant mesothelioma tumours: molecular pathogenesis, diagnosis, and therapies accompanying clinical studies

et al. 2023

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The pathetic malignant mesothelioma (MM) is a extremely uncommon and confrontational tumor that evolves in the mesothelium layer of the pleural cavities (inner lining- visceral pleura and outer lining- parietal pleura), peritoneum, pericardium, and tunica vaginalis and is highly resistant to standard treatments. In mesothelioma, the predominant pattern of lesions is a loss of genes that limit tumour growth. Despite the worldwide ban on the manufacture and supply of asbestos, the prevalence of mesothelioma continues to increase. Mesothelioma presents and behaves in a variety of ways, making diagnosis challenging. Most treatments available today for MM are ineffective, and the median life expectancy is between 10 and 12 months. However, in recent years, considerable progress has already been made in understanding the genetics and molecular pathophysiology of mesothelioma by addressing hippo signaling pathway. The development and progression of MM are related to many important genetic alterations. This is related to NF2 and/or LATS2 mutations that activate the transcriptional coactivator YAP. The X-rays, CT scans, MRIs, and PET scans are used to diagnose the MM. The MM are treated with surgery, chemotherapy, first-line combination chemotherapy, second-line treatment, radiation therapy, adoptive T-cell treatment, targeted therapy, and cancer vaccines. Recent clinical trials investigating the function of surgery have led to the development of innovative approaches to the treatment of associated pleural effusions as well as the introduction of targeted medications. An interdisciplinary collaborative approach is needed for the effective care of persons who have mesothelioma because of the rising intricacy of mesothelioma treatment. This article highlights the key findings in the molecular pathogenesis of mesothelioma, diagnosis with special emphasis on the management of mesothelioma.

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Malignant Pleural Effusions: Updates in Diagnosis and Management

Cited by 4 publications

References 56 publications

Short comparison of talc poudrage and tetracycline pleurodesis within patients suffering from malignant pleural effusion.

Short comparison of talc poudrage and tetracycline pleurodesis within patients suffering from malignant pleural effusion.

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

Malignant mesothelioma tumours: molecular pathogenesis, diagnosis, and therapies accompanying clinical studies

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