Thoracoscopic Management of Malignant Pleural Effusions

Yim, Anthony P.C.; Chung, Seungsoo; Lee, Tak Wai; Lam, Chuen Kwong; Ho, Jonathan K.

doi:10.1378/chest.109.5.1234

Cited by 52 publications

(26 citation statements)

References 31 publications

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“…Our data are in agreement with those of previous studies showing that talc is the pleurodesis agent of preference. (10)(11)(12)(13) Other agents, such as bleomycin and doxycycline, are not routinely used in South or Central America. However, approximately 10% of the respondents in Brazil reported using silver nitrate.…”

Section: Survivalmentioning

confidence: 99%

Pleurodese nos derrames pleurais malignos: um inquérito entre médicos em países da América do Sul e Central

et al. 2010

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Objective: Pleurodesis is an effective alternative for the control of malignant pleural effusions. However, there is as yet no consensus regarding the indications for the procedure and the techniques employed therein. The objective of this study was to evaluate how pleurodesis is performed in South and Central America. Methods: Professionals who perform pleurodesis completed a questionnaire regarding the indications for the procedure, the techniques used therein, and the outcomes obtained. Results: Our sample comprised 147 respondents in Brazil, 49 in other South American countries, and 36 in Central America. More than 50% of the respondents reported performing pleurodesis only if pleural malignancy had been confirmed. However, scores on dyspnea and performance status scales were rarely used as indications for the procedure. Nearly 75% of the respondents in Brazil and in Central America preferred to perform pleurodesis only for recurrent effusions and stated that lung expansion should be 90-100%. Talc slurry, instilled via medium-sized chest tubes, was the agent most often employed. Thoracoscopy was performed in less than 25% of cases. Fever and chest pain were the most common side effects, and empyema occurred in ≤ 14% of cases. The mean survival time after the procedure was most often reported to be 6-12 months. Conclusions: There was considerable variation among the countries evaluated in terms of the indications for pleurodesis, techniques used, and outcomes. Talc slurry is the agent most commonly used, and thoracoscopy is the technique of choice in Brazil. Pleurodesis is an effective procedure that has few side effects, as evidenced by the low complication rates and high survival times.Keywords: Pleural effusion, malignant; Pleura; Pleurodesis. ResumoObjetivo: A pleurodese é uma alternativa eficaz no controle dos derrames pleurais malignos, mas existem controvérsias a respeito de sua indicação e técnica. O objetivo deste estudo foi avaliar como é realizada a pleurodese em países da América do Sul e Central. Métodos: Profissionais que realizam pleurodese responderam um questionário sobre critérios de indicação para pleurodese, técnicas utilizadas e desfechos. Resultados: Nossa amostra envolveu 147 profissionais no Brasil, 49 em outros países da América do Sul e 36 em países da América Central. Mais de 50% dos participantes realizavam pleurodese somente se confirmada a malignidade no derrame pleural. Entretanto, escalas de dispneia e de status de performance eram raramente utilizadas para indicar o procedimento. Aproximadamente 75% dos participantes no Brasil e na América Central preferiam realizar a pleurodese somente no caso de recidiva do derrame, e a expansão pulmonar deveria variar de 90% a 100%. O talco slurry foi o agente mais utilizado, instilado via drenos de calibre intermediário. A toracoscopia foi realizada em menos de 25% dos casos. Febre e dor torácica foram os efeitos adversos mais comuns, e empiema ocorreu em ≤ 14% dos casos. A média de sobrevida após o procedimento variou entre 6 e 12...

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Section: Survivalmentioning

confidence: 99%

Pleurodese nos derrames pleurais malignos: um inquérito entre médicos em países da América do Sul e Central

et al. 2010

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“…However, less invasive procedures, such as a thoracoscopic approach and partial parietal pleurectomy, have shown efficacy in the management of MPE for highly selected patients [88,89].…”

Section: Surgical Managementmentioning

confidence: 99%

Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion

Rodríguez-Panadero

Janssen²,

Astoul³

2006

Eur Respir J

154

111

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“…When two or more studies of the pleural fluid including closed pleural biopsy fail to provide a diagnosis, a more invasive procedure such as thoracoscopic biopsy is probably the optimal choice because it has a lower risk than thoracotomy and has a diagnostic yield of 87% [1]. However, thoracoscopic procedures require general anaesthesia and have greater morbidity rates compared with a simple thoracentesis in this group of compromised patients with limited cardiorespiratory functions.…”

Section: Discussionmentioning

confidence: 99%

“…Although the diagnostic yield can reach up to 87% with more invasive thoracoscopic procedures, diagnosis of pleural effusions can be established in 33-72% of patients by conventional diagnostic methods [1][2][3]. Numerous procedures, including immunocytochemistry, chromosome analysis, tissue culture techniques, deoxyribonucleic acid (DNA) flow or image cytometry, and cell imaging combined with immunocytochemistry have been proposed for the differential diagnosis of pleural effusions to improve the sensitivity of cytological examination [4].…”

mentioning

confidence: 99%

Diagnostic implications of telomerase activity in pleural effusions

Dikmen¹,

Di̇kmen²,

Kara³

et al. 2003

Eur Respir J

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The aim of the present study was to investigate the diagnostic efficacy of telomerase activity for discrimination of malignant and benign pleural effusions.Pleural effusions were collected from 109 consecutive patients in whom the diagnosis was confirmed with cytological and/or histological examinations. Cytological samples were classified as malignant (n=63) and benign (n=46). Telomerase activity was determined with the polymerase chain reaction-based telomeric repeat amplification protocol assay.Telomerase activity was detected in 52 (82.5%) and nine (19.6%) samples from the malignant and benign groups, respectively, which was a significant difference. The sensitivity rate of cytological examination when combined with telomerase activity (92.1%) was significantly greater than that of cytological examination alone (53.9%). The sensitivity and specificity of telomerase activity were 82.5 and 80.4%, respectively. Diagnostic accuracy of telomerase activity was 81.6%.Telomerase activity is a highly sensitive diagnostic biomarker for malignancy and may be used as an adjunct to cytological findings in determining malignant pleural effusions. Eur Respir J 2003; 22: 422-426.

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Thoracoscopic Management of Malignant Pleural Effusions

Cited by 52 publications

References 31 publications

Pleurodese nos derrames pleurais malignos: um inquérito entre médicos em países da América do Sul e Central

Pleurodese nos derrames pleurais malignos: um inquérito entre médicos em países da América do Sul e Central

Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion

Diagnostic implications of telomerase activity in pleural effusions

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