Pleural biopsies in undiagnosed pleural effusions; Abrams vs image-guided vs thoracoscopic biopsies

Bibby, Anna; Maskell, Nick A

doi:10.1097/mcp.0000000000000258

Cited by 38 publications

(40 citation statements)

References 47 publications

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“…Unfortunately, cytological yield is low in MPM, and biopsies are usually required to confirm the diagnosis and identify the histological sub-type [1,35,38]. Biopsies can be obtained percutaneously under radiological guidance, or under direct vision at thoracoscopy, either as a local anaesthetic procedure (medical thoracoscopy) or as a surgical intervention (video-assisted thoracoscopic surgery (VATS)) [39]. The choice of biopsy technique will vary between patients depending on the distribution and morphology of their disease, their suitability for surgery or invasive procedures and the availability of services [39].…”

Section: Diagnosismentioning

confidence: 99%

“…Biopsies can be obtained percutaneously under radiological guidance, or under direct vision at thoracoscopy, either as a local anaesthetic procedure (medical thoracoscopy) or as a surgical intervention (video-assisted thoracoscopic surgery (VATS)) [39]. The choice of biopsy technique will vary between patients depending on the distribution and morphology of their disease, their suitability for surgery or invasive procedures and the availability of services [39]. The evidence for the various biopsy approaches has been discussed elsewhere and is not included in this article [39].…”

Section: Diagnosismentioning

confidence: 99%

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Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment

et al. 2016

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Malignant pleural mesothelioma is an aggressive malignancy of the pleural surface, predominantly caused by prior asbestos exposure. There is a global epidemic of malignant pleural mesothelioma underway, and incidence rates are predicted to peak in the next few years.This article summarises the epidemiology and pathogenesis of malignant pleural mesothelioma, before describing some key factors in the patient experience and outlining common symptoms. Diagnostic approaches are reviewed, including imaging techniques and the role of various biomarkers. Treatment options are summarised, including the importance of palliative care and methods of controlling pleural effusions. The evidence for chemotherapy, radiotherapy and surgery is reviewed, both in the palliative setting and in the context of trimodality treatment. An algorithm for managing malignant pleural effusion in malignant pleural mesothelioma patients is presented. Finally new treatment developments and novel therapeutic approaches are summarised.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment

et al. 2016

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“…Although thoracoscopic and video-assisted pleural biopsy have high specificity as minimally invasive procedures, they are not well tolerated by some patients, and may not be available in all hospitals (Bibby and Maskell 2016). Therefore, novel noninvasive methods able to differentiate MPEs from benign effusions are required.…”

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A machine learning evolutionary algorithm-based formula to assess tumor markers and predict lung cancer in cytologically negative pleural effusions

et al. 2019

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Malignant pleural effusion is diagnostically challenging in presence of negative cytology. The assessment of tumor markers in serum has become a standard tool in cancer diagnosis, while pleural fluid sampling has not met universal consensus. The evaluation of a panel of markers both in serum and pleural fluid may be crucial to improve the diagnostic accuracy. Using a machine learning-based approach, we provide a mathematical formula capable to express the complex relation existing among the expressed markers in serum and pleural effusion and the presence of lung cancer. The formula indicates CEA and CYFRA21-1 in pleural fluid as the best diagnostic markers, with 97% accuracy, 98% sensitivity, 95% specificity, 96% area under curve, 98% positive predictive value, and 92% MCC (Matthews correlation coefficient).

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“…As previously noted, TUS may also be used to guide more advanced pleural interventions, such as pleural biopsies or medical thoracoscopy. It has been demonstrated that this provides similar safety benefits by reducing the incidence of haemorrhage, pneumothorax and visceral injury, while also facilitating a high diagnostic yield of >90% [16][17][18][19][20][21].…”

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Thoracic ultrasound competence for ultrasound-guided pleural procedures

et al. 2019

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@ERSpublications Focused thoracic ultrasound is essential in the guidance of pleural interventions to reduce unwanted complications. It forms a crucial component of physician training. Current training standards and assessment methods vary.ABSTRACT Focused thoracic ultrasound has become essential in the guidance and direction of pleural interventions to reduce unwanted complications and as a result now forms a crucial component of physician training. Current training standards along with assessment methods vary widely, and are often not robust enough to ensure adequate competence. This review assesses the current state of training and assessment of thoracic ultrasound competence in various settings, allowing comparison with alternative competency based programmes. Future directions for training and assessment of thoracic ultrasound competence are discussed. Epidemiology and relevancePleural disease is common, with an estimated annual incidence of 3000 people per million population. This translates to approximately 200 000 new cases of pleural disease yearly in the UK and this incidence continues to rise, therefore representing a significant burden on healthcare systems. There are more than 40 000 new cases of malignant pleural effusion in the UK annually, contributing to an annual incidence of approximately 300 000 cases across the USA and UK combined. Incidence rates for all cancers combined in the UK have increased by 7% over the past 10 years and are projected to rise by a further 2% between 2014 and 2035 to 742 cases per 100 000, which is likely to result in an ongoing increase in the incidence of malignant pleural effusion. In addition, there are approximately 2500 deaths per year in the UK from mesothelioma. The incidence has steadily risen over the past 50 years and is expected to peak in 2020 [1-5].The combined UK and US population also has an estimated annual incidence of 80 000 cases of pleural infection. This frequency has doubled over the past decade and continues to rise [6,7]. Role of ultrasound for pleural proceduresAs the prevalence of pleural disease has continued to rise, so has the need for increasingly specialised interventions. This includes local anaesthetic thoracoscopy with or without pneumothorax induction, pleural biopsy and indwelling catheter insertion along with more traditional procedures such as pleural aspiration and chest drain insertion. The role of ultrasound guidance for these procedures has also increased. A Intermediate-level TUS operatorMinimum of 2 years' experience as a basic-level TUS operator Ability to detect A-lines and B-lines in lung ultrasound Ability to identify and assess pleural thickening Ability to assess diaphragm function on ultrasound Ability to perform real-time pleural aspiration and chest drain insertion when required Ability to use ultrasound help guide site for indwelling pleural catheter insertion (scanning patients in lateral decubitus position) Annual review and appraisal of practice including standardised outcome measures Advanced-level TUS operator...

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Pleural biopsies in undiagnosed pleural effusions; Abrams vs image-guided vs thoracoscopic biopsies

Cited by 38 publications

References 47 publications

Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment

Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment

A machine learning evolutionary algorithm-based formula to assess tumor markers and predict lung cancer in cytologically negative pleural effusions

Thoracic ultrasound competence for ultrasound-guided pleural procedures

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