Management of Malignant Pleural Effusions

Spector, Marcelo; Pollak, Jeffrey

doi:10.1055/s-2008-1081283

Cited by 24 publications

(8 citation statements)

References 48 publications

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“…Spontaneous pleurodesis have been reported in 21–58% patients; however, symptomatic improvement occurs in 81–100% patients. [37] Complications are generally low (5–27%) and includes bleeding, pneumothorax, cellulitis, empyema, catheter obstruction with subsequent tension pleural effusion and tumor spread along the catheter tract, etc. [38] This method is becoming increasingly popular in view of reduced hospitalizations, recovery time and overall cost.…”

Section: Indwelling Tunneled Pleural Cathetermentioning

confidence: 99%

Diagnosis and management options in malignant pleural effusions

et al. 2017

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Malignant pleural effusion (MPE) denotes an advanced malignant disease process. Most of the MPE are metastatic involvement of the pleura from primary malignancy at lung, breast, and other body sites apart from lymphomas. The diagnosis of MPE has been traditionally made on cytological examination of pleural fluid and/or histological examination of pleural biopsy tissue that still remains the initial approach in these cases. There has been tremendous advancement in the diagnosis of MPE now a day with techniques i.e. characteristic Ultrasound and computed tomography features, image guided biopsies, fluorodeoxyglucose-positron emission tomography imaging, thoracoscopy with direct biopsy under vision, tumor marker studies and immunocytochemical analysis etc., that have made possible an early diagnosis of MPE. The management of MPE still remains a challenge to pulmonologist and oncologist. Despite having various modalities with better tolerance such as pleurodesis and indwelling pleural catheters etc., for long-term control, all the management approaches remain palliative to improve the quality of life and reduce symptoms. While choosing an appropriate management intervention, one should consider the clinical status of the patient, life expectancy, overall cost, availability and comparative institutional outcomes, etc.

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Section: Indwelling Tunneled Pleural Cathetermentioning

confidence: 99%

Diagnosis and management options in malignant pleural effusions

et al. 2017

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“…According to clinical risk factors and prognosis, pleural effusion can be divided into two categories, benign and malignant (4). The most common cause of benign pleural effusion is tuberculosis (TB), and that of malignant pleural effusion (MPE) is lung and breast cancer (5).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of interleukin 22 and carcinoembryonic antigen in tuberculous and malignant pleural effusions

Jin

Chen

Wang

et al. 2011

Experimental and Therapeutic Medicine

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Abstract. The aim of this study was to investigate the diagnostic value of interleukin 22 (IL-22) and carcinoembryonic antigen (CEA) in tuberculous pleural effusions (TPEs) and malignant pleural effusions (MPEs). Pleural effusion samples from 56 patients were classified on the basis of diagnosis as TPE (n=28) and MPE (n=28). The concentration of IL-22 was determined by ELISA. Lactate dehydrogenase (LDH), adenosine dehydrogenase (ADA) and CEA levels were also determined in all patients. A significant difference was observed in the levels of ADA and CEA (P<0.01), but not in the levels of LDH (P>0.05) between TPE and MPE. The concentration of IL-22 in TPE was significantly higher compared to MPE (P<0.01). With a threshold value of 49 pg/ml, IL-22 had a sensitivity of 82.14% (23/28) and a specificity of 96.43% (27/28) for differential diagnosis. The combined detection of IL-22 and CEA had a sensitivity of 100% (28/28) and a specificity of 96.43% (27/28) to distinguish TPE from MPE. TPEs showed significantly higher levels of IL-22 compared to MPEs. The combined detection of IL-22 and CEA may be more valuable in the differential diagnosis between TPE and MPE. IntroductionPleural effusion is one of the most common clinical manifestations of pleural diseases (1-3). According to clinical risk factors and prognosis, pleural effusion can be divided into two categories, benign and malignant (4). The most common cause of benign pleural effusion is tuberculosis (TB), and that of malignant pleural effusion (MPE) is lung and breast cancer (5). Due to different risk factors and prognosis, it is necessary to differentiate between them. However, this remains a major clinical problem. Although the presence of tumor cells in pleural effusion is a diagnostic marker of MPE, the probability of finding them is low. For cytology-negative pleural effusion, some of the currently used indices, such as lactate dehydrogenase (LDH), adenosine dehydrogenase (ADA) and carcinoembryonic antigen (CEA), have a certain extent of differential value, however, their specificity and sensitivity are limited. Due to the fear of possible trauma caused by thoracoscopy, some patients are not keen to agree on such a procedure. Therefore, searching for new indices is very important.The improved understanding of pleural effusion immunopathogenesis could lead to the development of new immunodiagnostic tools to facilitate its differential diagnosis. The main cellular components in both tuberculous pleural effusions (TPEs) and MPEs are lymphocytes. Previous research data have reported that lymphocytes play an important regulatory role in the pathogenesis of pleural effusion (1,2). Inflammation leads to the accumulation of lymphocytes in the pleural cavity, which release a variety of mediators and cytokines influencing pleural capillary permeability, resulting in pleural effusion (6,7). Large scale studies have reported that CD4 + T lymphocytes play an important role in the pathogenesis of pleural effusion (7). CD4 + T cells can be differentiated into Th1, Th2, Th17...

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“…Repeated thoracentesis carries an increased risk of pneumothorax, empyema, and loculation and therefore should be performed only in emergency situations or as a palliative measure for patients at the end of life. 5 Pleuroperitoneal shunts also have fallen out of favor because of their difficult maintenance resulting in high rates of patient noncompliance and occlusion of the shunt. 6 It is not uncommon for a patient to present with a malignant pleural effusion before the diagnosis of cancer.…”

Section: Traditional Methods Of Managementmentioning

confidence: 98%