Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single‐centre experience

Leemans, Joke; Dooms, Christophe; Ninane, Vincent; Yserbyt, Jonas

doi:10.1111/resp.13252

Cited by 21 publications

(24 citation statements)

References 16 publications

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“…The phenomenon was explained by a better transmission of heart beats through the atelectatic lung. The lung pulse has also been observed in the M-mode chest ultrasonography in patients with pleural effusion and atelectatic lung [4][5][6][7]. On the basis of our observations, we propose that pleural manometry could be a more sensitive and more accurate measure of pleural pulsations, albeit more invasive, than the M-mode US imaging.…”

Section: Discussionsupporting

confidence: 60%

“…It has been demonstrated that heart cyclic contractions generate blood flow in large vessels and can also interact with adjacent organs by passing on pulsations. This is exemplified by the so-called "lung pulse" which was first described as an early ultrasound sign of complete lung atelectasis [3], and later, also reported in patients with pleural effusion [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Pleural Pressure Pulse in Patients with Pleural Effusion: A New Phenomenon Registered during Thoracentesis with Pleural Manometry

Grabczak

Michnikowski

Styczyński

et al. 2020

JCM

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Pleural manometry enables the assessment of physiological abnormalities of lung mechanics associated with pleural effusion. Applying pleural manometry, we found small pleural pressure curve oscillations resembling the pulse tracing line. The aim of our study was to characterize the oscillations of pleural pressure curve (termed here as the pleural pressure pulse, PPP) and to establish their origin and potential significance. This was an observational cross-sectional study in adult patients with pleural effusion who underwent thoracentesis with pleural manometry. The pleural pressure curves recorded prior to and during fluid withdrawal were analyzed. The presence of PPP was assessed in relation to the withdrawn pleural fluid volume, lung expandability, vital and echocardiographic parameters, and pulmonary function testing. A dedicated device was developed to compare the PPP to the pulse rate. Fifty-four patients (32 women) median age 66.5 (IQR 58.5–78.7) years were included. Well visible and poorly visible pressure waves were detected in 48% and 35% of the patients, respectively. The frequency of PPP was fully concordant with the pulse rate and the peaks of the oscillations reflected the period of heart diastole. PPP was more visible in patients with a slower respiratory rate (p = 0.008), a larger amount of pleural effusion, and was associated with a better heart systolic function assessed by echocardiography (p < 0.05). This study describes a PPP, a new pleural phenomenon related to the cyclic changes in the heart chambers volume. Although the importance of PPP remains largely unknown, we hypothesize that it could be related to lung atelectasis or lower lung and visceral pleura compliance.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Pleural Pressure Pulse in Patients with Pleural Effusion: A New Phenomenon Registered during Thoracentesis with Pleural Manometry

Grabczak

Michnikowski

Styczyński

et al. 2020

JCM

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“…Published in Respirology , Leemans et al . conducted a retrospective responder analysis of 155 patients who underwent TP via medical thoracoscopy . Their success rate was in keeping with previous studies at 78%.…”

Section: Pleural Diseasementioning

confidence: 64%

Contemporary Concise Review 2018: Lung cancer and pleural disease

et al. 2019

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“…In an earlier retrospective study, Leemans et al . reported similar adverse survival (median OS: 66 vs 169 days) in patients with MPE (due to a range of tumour types) who failed thoracoscopic talc pleurodesis due to NEL . In MPM, visceral pleural tumour, a frequent cause of NEL, has historically been associated with adverse survival via higher disease stage .…”

Section: Discussionmentioning

confidence: 87%

Inter‐observer variation in image interpretation and the prognostic importance of non‐expansile lung in malignant pleural effusion

et al. 2019

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Background and objective Non‐expansile lung (NEL) frequently complicates management of malignant pleural effusion (MPE) and is an important factor in clinical practice and trials. NEL is frequently diagnosed on a single radiographic observation, but neither the inter‐observer agreement of this approach nor the prognostic importance of NEL in MPE has been reported. Methods A multicentre retrospective cohort study was performed in two UK pleural centres. NEL was defined as <50% pleural re‐apposition on post‐drainage radiographs by primary and secondary assessors at each site. Inter‐observer agreement was assessed by Cohen's kappa (κ). Kaplan–Meier methodology and multivariate Cox models were used to assess the prognostic impact of NEL versus no NEL and ‘complete NEL’ versus ‘complete expansion’, based on a single assessor's results from each site. Results NEL was identified by the primary assessor in 33 of 97 (34%) in Cohort 1 and 15 of 86 (17%) in Cohort 2. Inter‐observer agreement between assessors was only fair‐to‐moderate (Cohort 1 κ: 0.38 (95% CI: 0.21–0.55), Cohort 2 κ: 0.51 (95% CI: 0.30–0.72)). In both cohorts, NEL was associated with shorter median overall survival (Cohort 1: 188 vs 371 days, Cohort 2: 192 vs 412 days). This prognostic association was independent in Cohort 1 (hazard ratio (HR): 2.19, 95% CI: 1.31–3.66) but not in Cohort 2 (HR: 1.42, 95% CI: 0.71–2.87). Survival was inferior in both cohorts in cases of complete NEL versus complete expansion. Conclusion Radiographic NEL is common but inter‐observer agreement is only fair‐to‐moderate. NEL is associated with adverse survival. These data do not support the use of single radiographic assessments to classify NEL.

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Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single‐centre experience

Abstract: The success rate of pleurodesis in malignant pleurisy could potentially be enhanced by correct patient selection and early referral for pleurodesis. Ultrasonic assessment of pleural adhesions and potential lung expansion prior to pleurodesis is useful in clinical decision-making.

Cited by 21 publications

References 16 publications

Pleural Pressure Pulse in Patients with Pleural Effusion: A New Phenomenon Registered during Thoracentesis with Pleural Manometry

Pleural Pressure Pulse in Patients with Pleural Effusion: A New Phenomenon Registered during Thoracentesis with Pleural Manometry

Contemporary Concise Review 2018: Lung cancer and pleural disease

Inter‐observer variation in image interpretation and the prognostic importance of non‐expansile lung in malignant pleural effusion

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