Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Malignant Pleural Effusion: Medical Approaches for Diagnosis and Management

  • Nam, Hae-Seong (Center for Lung Cancer and Division of Pulmonary, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine)
  • Received : 2014.02.20
  • Accepted : 2014.03.06
  • Published : 2014.05.30
Download PDF
⟨ Previous Next ⟩

Abstract

Malignant pleural effusions (MPEs) are the second leading cause of exudative pleural effusions after parapneumonic effusions. In the vast majority of cases, a MPE signifies incurable disease associated with high morbidity and mortality. Considerable advances have been made for the diagnosis of MPEs, through the development of improved methods in the specialized cytological and imaging studies. The cytological or histological confirmation of malignant cells is currently important in establishing a diagnosis. Furthermore, despite major advancements in cancer treatment for the past two decades, management of MPE remains palliative. This article presents a comprehensive review of the medical approaches for diagnosis and management of MPE.

Keywords

References

  1. Thomas JM, Musani AI. Malignant pleural effusions: a review. Clin Chest Med 2013;34:459-71. https://doi.org/10.1016/j.ccm.2013.05.004
  2. Light RW. Pleural diseases. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2013.
  3. Heffner JE, Klein JS. Recent advances in the diagnosis and management of malignant pleural effusions. Mayo Clin Proc 2008;83:235-50. https://doi.org/10.1016/S0025-6196(11)60848-3
  4. Heffner JE, Nietert PJ, Barbieri C. Pleural fluid pH as a predictor of survival for patients with malignant pleural effusions. Chest 2000;117:79-86. https://doi.org/10.1378/chest.117.1.79
  5. Bielsa S, Salud A, Martinez M, Esquerda A, Martin A, Rodriguez- Panadero F, et al. Prognostic significance of pleural fluid data in patients with malignant effusion. Eur J Intern Med 2008;19:334-9. https://doi.org/10.1016/j.ejim.2007.09.014
  6. Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007;2:706-14. https://doi.org/10.1097/JTO.0b013e31812f3c1a
  7. Ryu JS, Ryu HJ, Lee SN, Memon A, Lee SK, Nam HS, et al. Prognostic impact of minimal pleural effusion in non-smallcell lung cancer. J Clin Oncol 2014;32:960-7. https://doi.org/10.1200/JCO.2013.50.5453
  8. Chernow B, Sahn SA. Carcinomatous involvement of the pleura: an analysis of 96 patients. Am J Med 1977;63:695-702. https://doi.org/10.1016/0002-9343(77)90154-1
  9. Alkhawaldeh K, Biersack HJ, Henke A, Ezziddin S. Impact of dual-time-point F-18 FDG PET/CT in the assessment of pleural effusion in patients with non-small-cell lung cancer. Clin Nucl Med 2011;36:423-8. https://doi.org/10.1097/RLU.0b013e3182173823
  10. Ashchi M, Golish J, Eng P, O'Donovan P. Transudative malignant pleural effusions: prevalence and mechanisms. South Med J 1998;91:23-6. https://doi.org/10.1097/00007611-199801000-00004
  11. Ryu JS, Ryu ST, Kim YS, Cho JH, Lee HL. What is the clinical significance of transudative malignant pleural effusion? Korean J Intern Med 2003;18:230-3. https://doi.org/10.3904/kjim.2003.18.4.230
  12. Liang QL, Shi HZ, Qin XJ, Liang XD, Jiang J, Yang HB. Diagnostic accuracy of tumour markers for malignant pleural effusion: a meta-analysis. Thorax 2008;63:35-41. https://doi.org/10.1136/thx.2007.077958
  13. Shi HZ, Liang QL, Jiang J, Qin XJ, Yang HB. Diagnostic value of carcinoembryonic antigen in malignant pleural effusion: a meta-analysis. Respirology 2008;13:518-27. https://doi.org/10.1111/j.1440-1843.2008.01291.x
  14. Ishimoto O, Saijo Y, Narumi K, Kimura Y, Ebina M, Matsubara N, et al. High level of vascular endothelial growth factor in hemorrhagic pleural effusion of cancer. Oncology 2002;63:70-5. https://doi.org/10.1159/000065723
  15. Shen YC, Liu MQ, Wan C, Chen L, Wang T, Wen FQ. Diagnostic accuracy of vascular endothelial growth factor for malignant pleural effusion: a meta-analysis. Exp Ther Med 2012;3:1072-6. https://doi.org/10.3892/etm.2012.514
  16. Davies HE, Sadler RS, Bielsa S, Maskell NA, Rahman NM, Davies RJ, et al. Clinical impact and reliability of pleural fluid mesothelin in undiagnosed pleural effusions. Am J Respir Crit Care Med 2009;180:437-44. https://doi.org/10.1164/rccm.200811-1729OC
  17. Pass HI, Levin SM, Harbut MR, Melamed J, Chiriboga L, Donington J, et al. Fibulin-3 as a blood and effusion biomarker for pleural mesothelioma. N Engl J Med 2012;367:1417-27. https://doi.org/10.1056/NEJMoa1115050
  18. Porcel JM. Pleural fluid biomarkers: beyond the Light criteria. Clin Chest Med 2013;34:27-37. https://doi.org/10.1016/j.ccm.2012.11.002
  19. Sriram KB, Relan V, Clarke BE, Duhig EE, Yang IA, Bowman RV, et al. Diagnostic molecular biomarkers for malignant pleural effusions. Future Oncol 2011;7:737-52. https://doi.org/10.2217/fon.11.45
  20. Loddenkemper R. Thoracoscopy: state of the art. Eur Respir J 1998;11:213-21. https://doi.org/10.1183/09031936.98.11010213
  21. Maskell NA, Gleeson FV, Davies RJ. Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of malignant disease in pleural effusions: a randomised controlled trial. Lancet 2003;361:1326-30. https://doi.org/10.1016/S0140-6736(03)13079-6
  22. Musani AI. Treatment options for malignant pleural effusion. Curr Opin Pulm Med 2009;15:380-7. https://doi.org/10.1097/MCP.0b013e32832c6a8a
  23. Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ; BTS Pleural Disease Guideline Group. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65 Suppl 2:ii32-40.
  24. Uzbeck MH, Almeida FA, Sarkiss MG, Morice RC, Jimenez CA, Eapen GA, et al. Management of malignant pleural effusions. Adv Ther 2010;27:334-47. https://doi.org/10.1007/S12325-010-0031-8
  25. Myers R, Michaud G. Tunneled pleural catheters: an update for 2013. Clin Chest Med 2013;34:73-80. https://doi.org/10.1016/j.ccm.2012.12.003
  26. Davies HE, Mishra EK, Kahan BC, Wrightson JM, Stanton AE, Guhan A, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA 2012;307:2383-9. https://doi.org/10.1001/jama.2012.5535
  27. Rodriguez-Panadero F, Montes-Worboys A. Mechanisms of pleurodesis. Respiration 2012;83:91-8. https://doi.org/10.1159/000335419
  28. Tan C, Sedrakyan A, Browne J, Swift S, Treasure T. The evidence on the effectiveness of management for malignant pleural effusion: a systematic review. Eur J Cardiothorac Surg 2006;29:829-38. https://doi.org/10.1016/j.ejcts.2005.12.025
  29. Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med 1994;120:56-64. https://doi.org/10.7326/0003-4819-120-1-199401010-00010
  30. Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev 2004;(1):CD002916.
  31. Paschoalini Mda S, Vargas FS, Marchi E, Pereira JR, Jatene FB, Antonangelo L, et al. Prospective randomized trial of silver nitrate vs talc slurry in pleurodesis for symptomatic malignant pleural effusions. Chest 2005;128:684-9. https://doi.org/10.1378/chest.128.2.684
  32. Mohsen TA, Zeid AA, Meshref M, Tawfeek N, Redmond K, Ananiadou OG, et al. Local iodine pleurodesis versus thoracoscopic talc insufflation in recurrent malignant pleural effusion: a prospective randomized control trial. Eur J Cardiothorac Surg 2011;40:282-6.
  33. Ren S, Terman DS, Bohach G, Silvers A, Hansen C, Colt H, et al. Intrapleural staphylococcal superantigen induces resolution of malignant pleural effusions and a survival benefit in non-small cell lung cancer. Chest 2004;126:1529-39. https://doi.org/10.1378/chest.126.5.1529
  34. Janssen JP, Collier G, Astoul P, Tassi GF, Noppen M, Rodriguez- Panadero F, et al. Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet 2007;369:1535-9. https://doi.org/10.1016/S0140-6736(07)60708-9
  35. Puri V, Pyrdeck TL, Crabtree TD, Kreisel D, Krupnick AS, Colditz GA, et al. Treatment of malignant pleural effusion: a cost-effectiveness analysis. Ann Thorac Surg 2012;94:374-9. https://doi.org/10.1016/j.athoracsur.2012.02.100
  36. Nam HS, Ryu JS. Diagnosis and management of malignant pleural effusion. Korean J Med 2011;81:167-73.

Cited by

  1. Important prognostic factors for survival in patients with malignant pleural effusion vol.15, pp.None, 2014, https://doi.org/10.1186/s12890-015-0025-z
  2. Palliativmedizin in der thorakalen Onkologie vol.13, pp.2, 2014, https://doi.org/10.1007/s10405-015-0025-y
  3. Primary Malignant Neuroendocrine Tumour of Pleura: First Case Report vol.2016, pp.None, 2016, https://doi.org/10.1155/2016/5462380
  4. Trends in Pleural Effusion Research : A Bibliometric Analysis From the Scopus Database vol.3, pp.None, 2016, https://doi.org/10.1177/2373997516646555
  5. Outcomes in Critically Ill Patients with Cancer-Related Complications vol.11, pp.10, 2014, https://doi.org/10.1371/journal.pone.0164537
  6. Transudative pleural effusion of malignant etiology: Rare but real vol.20, pp.None, 2017, https://doi.org/10.1016/j.rmcr.2017.02.015
  7. Diagnostic Value of Neuron-Specific Enolase (NSE) and Cancer Antigen 15-3 (CA 15-3) in the Diagnosis of Pleural Effusions vol.18, pp.1, 2014, https://doi.org/10.22034/apjcp.2017.18.1.257
  8. A Panel of Novel Detection and Prognostic Methylated DNA Markers in Primary Non–Small Cell Lung Cancer and Serum DNA vol.23, pp.22, 2014, https://doi.org/10.1158/1078-0432.ccr-17-1222
  9. Prognostic impact of a new score using neutrophil-to-lymphocyte ratios in the serum and malignant pleural effusion in lung cancer patients vol.17, pp.None, 2014, https://doi.org/10.1186/s12885-017-3550-8
  10. The role of VEGF in the diagnosis and treatment of malignant pleural effusion in patients with non-small cell lung cancer vol.17, pp.6, 2014, https://doi.org/10.3892/mmr.2018.8922
  11. Video-assisted thoracic surgery ( conventional and single-port ) - place and role in the improved management of malignant pleural effusions: review article vol.16, pp.3, 2014, https://doi.org/10.15547/tjs.2018.03.012
  12. Thymidine kinase 1 concentration in pleural effusion is a diagnostic marker and survival predictor for malignant pleural effusion vol.33, pp.6, 2014, https://doi.org/10.1002/jcla.22901
  13. Are we ready to develop a tiered scheme for the effusion cytology? A comprehensive review and analysis of the literature vol.47, pp.11, 2019, https://doi.org/10.1002/dc.24278
  14. Diagnostic value of human epididymis protein 4 in malignant pleural effusion in lung cancer vol.26, pp.4, 2014, https://doi.org/10.3233/cbm-190840
  15. Multiplexed molecular profiling of lung cancer with malignant pleural effusion using next generation sequencing in Chinese patients vol.19, pp.5, 2020, https://doi.org/10.3892/ol.2020.11446
  16. Machine learning applied to near-infrared spectra for clinical pleural effusion classification vol.11, pp.1, 2014, https://doi.org/10.1038/s41598-021-87736-4
  17. Intrapleural treatment in patients with non‐small cell lung cancer with malignant pleural effusions in the real world vol.12, pp.24, 2014, https://doi.org/10.1111/1759-7714.14224