Should We Really Compare Indwelling Pleural Catheters to Any Pleurodesis?

Froudarakis, Marios

doi:10.1159/000362693

Cited by 3 publications

(5 citation statements)

References 38 publications

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Section: Resultsmentioning

confidence: 99%

“…Talc is currently the best sclerosing agent shown to be effective, safe, and cheap and providing long-lasting results [3] . Pleurodesis is achieved mostly by talc insufflation into the pleural cavity performed under thoracoscopy [3] . Thoracoscopic pleurodesis is reserved for patients with a good health status and a relatively long life expectancy, in whom a histological diagnosis and anatomic and molecular staging of the disease, lead to changes in the treatment strategy [12] .…”

Section: Resultsmentioning

confidence: 99%

“…Many factors exist for negative results in minimal invasive procedures such as the histology of the primary tumor, and the pattern as well as the extent of invasion of the pleural cavity [2] . Therefore, when there is a strong clinical suspicion of malignancy, patients will undergo thoracoscopy, medical or surgical, in order to diagnose the effusion cause and, if malignant, proceed to pleurodesis, the treatment that will prevent fluid recurrence and palliate dyspnea, thus improving patient's quality of life [1,3] .…”

mentioning

confidence: 99%

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Frozen Sections in Pleural Pathology: A Valuable Tool

Karpathiou

Froudarakis²,

Forest³

et al. 2017

Respiration

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Background: Knowledge of pleural malignancy can lead to immediate pleurodesis during thoracoscopy. However, the accuracy of pleural frozen sections is largely unknown. Objectives: To investigate the accuracy of frozen sections in pleural tumor pathology. Methods: A total of 156 frozen pleural sections performed with the question of malignancy were retrospectively reviewed. The original frozen sections were compared to the permanent section slides which were considered as the gold standard. The influence of the following parameters on the frozen section response was evaluated: specimen size, clinical information, as well as the processing by a specialized pulmonary pathologist or not. The reasons of discrepancies were categorized as sampling errors or interpretation errors. Results: Frozen sections made up 16.4% of 951 pleural biopsies performed in the same time period. Accurate diagnosis was feasible in 92.3% of the cases. There were 7 (4.5%) deferred (inconclusive) cases and 5 (3.2%) discrepant cases. Sensitivity of the method was 96.26%, specificity 97.87%, the positive predictive value was 99.04%, and the negative predictive value was 92%. There was no association between the responses given during frozen section and specimen size, clinical information, or the evaluation by a specialized pulmonary pathologist. Four of the 12 cases were sampling errors, while 8 cases were interpretation errors mostly made in the absence of fat tissue invasion. Thus, paucicellular lesions without prominent invasion - fat invasion or haphazardly invading cellular proliferation - were those posing most of the difficulties during frozen section. Conclusions: Frozen sections are a highly accurate tool in pleural pathology. Thus, they can be used when an immediate pleurodesis is requested.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Frozen Sections in Pleural Pathology: A Valuable Tool

Karpathiou

Froudarakis²,

Forest³

et al. 2017

Respiration

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“…They found that there was similar effectiveness of quality adjusted life years (QALYs), however talc pleurodesis was less costly (talc, 0.281 QALYs and $8170.80; Pleurx, 0.276 QALYs and $9011.60) [ 21 ]. Froudarakis compared the cost of repeated thoracentesis and pleurodesis and found that repeat thoracentesis was the cheapest intervention at three-month survival where bedside pleurodesis became the cheapest at 12-month analysis (thoracentesis $4946; pleurodesis $13057) [ 22 ]. However, Froudarakis felt that indwelling pleural catheters were difficult to compare to other treatments because patient selection, techniques, and complications are different with these devices [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Froudarakis compared the cost of repeated thoracentesis and pleurodesis and found that repeat thoracentesis was the cheapest intervention at three-month survival where bedside pleurodesis became the cheapest at 12-month analysis (thoracentesis $4946; pleurodesis $13057) [ 22 ]. However, Froudarakis felt that indwelling pleural catheters were difficult to compare to other treatments because patient selection, techniques, and complications are different with these devices [ 22 ]. More research comparing quality adjusted life years, cost and complications is recommended for future studies.…”

Section: Discussionmentioning

confidence: 99%

A Sleeve-Sheath With a Coaxial Exchangeable Catheter for Palliative Evacuation of Recurrent Thoracic and Abdominal Effusions

Malone¹,

Stevens²,

Merriman³

et al. 2022

Cureus

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Herein we describe an outer cannula sleeve-sheath with a coaxially inserted exchangeable drainage catheter (SCDC) for effective evacuation of recurrent symptomatic fluid collections in the thorax and abdomen on patients in lieu of, or failed, current evacuation catheters and methods. The design is an alternative to existing commercially available devices and adds distinct enhancements with the possibility of intrathoracic or intrabdominal trans outer sleeve-sheath diagnostic or therapeutic interventions. This device aims at requiring a single invasive procedure (thoracentesis and paracentesis) while offering catheter exchange and repositioning if malfunction or malposition occurs during the patient’s lifetime. The SCDC outer sheath in the subcutaneous tissues of the thorax or abdomen has built-in two antibacterial cuffs to prevent infection. At the same time, the exchangeable coaxially inserted drainage catheter is deployed over a guidewire within the thoracic or abdominal cavities. The drainage catheter has a fluid dynamic proven efficient design to facilitate drainage and can recanalize its lumen if occluded by fibrin or tissue.

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