Non‐specific pleuritis in patients with active malignancy

Vakil, Erik; Ost, David; Vial, Macarena R.; Stewart, John; Sarkiss, Mona; Morice, Rodolfo C.; Casal, Roberto F.; Eapen, Georgie A.; Grosu, Horiana B.

doi:10.1111/resp.13187

Cited by 25 publications

(29 citation statements)

References 29 publications

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“…Interestingly, all 3 complained of persistent pleural pain, which was also found by Metintas in his cases of originally false‐negative mesothelioma . In Vakil’s study, the authors speculated that in patients with active malignancy 6 months would be sufficient for follow‐up of non‐specific pleural effusion . In the study of Yang, the time to cancer diagnosis was 4.1 ± 3.4 months .…”

Section: Follow Up Of Nsp Patientsmentioning

confidence: 68%

“…In this study, he defined benign pleural inflammation as histopathological‐proven and/or when clinical characteristics consistent with chemotherapy‐induced pleuritis (CIP), possible radiation‐induced pleuritis (RIP), other premalignant pleuritis, or infectious pleuritis, were present. Patients had to demonstrate no evidence of malignancy for a minimum of 6 month follow‐up . CIP was defined as pleural effusion in a patient receiving chemotherapy known to be associated with pleural effusions, and who had no other cause of pleural effusion.…”

Section: Definition Of Nspmentioning

confidence: 99%

“…In his early work on thoracoscopic diagnosis of pleural disease, Boutin advised to take up to 15‐20 biopsies of parietal pleura, of widely separate regions of the pleura, including the diaphragm and the costovertebral gutter, even in the case of normal looking pleura . In Vakil’s study, a median of 10 biopsies was obtained …”

Section: Number Of Required Biopsiesmentioning

confidence: 99%

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What is the significance of non‐specific pleuritis? A trick question

Janssen

Maldonado

Metintaş

2018

Clinical Respiratory J

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Non-specific pleuritis (NSP) is defined as fibrinous or inflammatory pleuritis which cannot be attributed to a specific benign or malignant etiology. It can be diagnosed in biopsies in up to 30% of cases of exudative pleuritis after thoracoscopy, with a mean of 19.2%. In 66 out of 469 (14.2%) patients in combined series, a malignant pleural disease (mostly mesothelioma) was found during a follow-up of at least 21 months. Most likely, a follow-up time of 12 months is sufficient, although the current routine is a follow-up of 2 years. Because of a benign course in 85% of patients with NSP, a repeated invasive procedure after thoracoscopy is only indicated in a limited group of patients. The most important indications for a repeated pleural biopsy are persistent chest pain, recurrent pleural effusion, radiologic findings suggestive for malignant pleural disease.

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Section: Follow Up Of Nsp Patientsmentioning

confidence: 68%

Section: Definition Of Nspmentioning

confidence: 99%

Section: Number Of Required Biopsiesmentioning

confidence: 99%

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What is the significance of non‐specific pleuritis? A trick question

Janssen

Maldonado

Metintaş

2018

Clinical Respiratory J

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“…Specific Benign Effusion Pleural effusions with characteristics consistent with chemotherapy-induced pleuritis, radiation-induced pleuritis, paramalignant pleural effusions, or infectious pleuritis. Definitions for specific benign effusion were previously described in cases where a pleural biopsy was done [16]. In those cases where pleural biopsy was not done, the final diagnosis was assigned by the multidisciplinary oncology and pulmonary team on the basis of a review of their clinical, pathologic, microbiologic, and radiologic data, with follow-up for at least 6 months.…”

Section: Malignant Pleural Effusionmentioning

confidence: 99%

Sensitivity of Initial Thoracentesis for Malignant Pleural Effusion Stratified by Tumor Type in Patients with Strong Evidence of Metastatic Disease

et al. 2018

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Background: Thoracentesis with cytological examination of pleural fluid is the initial test of choice for evaluation of pleural effusions in patients with suspected malignant pleural effusion (MPE). There is limited data on the sensitivity of thoracentesis stratified by tumor type. A better understanding of stratified sensitivities is of clinical interest, and may guide early and appropriate referral for pleural biopsy. Objective: The primary objective was sensitivity of thoracentesis with pleural fluid cytology stratified by tumor type. Methods: This is a retrospective cohort study of consecutive patients with a solid tumor malignancy with proven or strong suspicion for metastatic disease with new pleural effusions that underwent an initial thoracentesis. Only patients with metastatic disease were included. Results: Of the 725 patients examined, 63% had pleural fluid cytology positive for malignancy. Sensitivity of thoracentesis varied from a low of 0.38 (95% CI 0.13–0.68) in head and neck malignancy, 0.38 (95% CI 0.15–0.65) in sarcoma, and 0.53 (95% CI 0.34–0.72) in renal cancer to a high of 93 (95% CI 88–97) in breast cancer, and 100 (95% CI 0.82–100) in pancreatic cancer. Factors associated with an increased risk of MPE included larger amount of fluid drained (p = 0.014) and higher pleural fluid protein (p = 0.002). The only factor associated with decreased risk of MPE if first cytology was negative for malignancy was the presence of contralateral effusion (p = 0.005). Conclusions: Sensitivity of thoracentesis for solid tumors varies significantly depending on the type of tumor and is lowest in those with sarcomas, head and neck malignancies, and renal cell cancers.

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“…In this issue of Respirology , Vakil et al . report on the true negative rate of pleuroscopy in the investigation of pleural effusions in patients with known active malignancy.…”

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confidence: 99%