Contemporary Approach to the Diagnosis of Malignant Pleural Effusion

Kaul, Viren; McCracken, David J.; Rahman, Najib M.; Epelbaum, Oleg

doi:10.1513/annalsats.201902-189cme

Cited by 24 publications

(15 citation statements)

References 69 publications

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“…But the diagnostic sensitivity of cytology is limited and varies with underlying cancer types [ 6 , 7 , 21 ]. Pleural biopsy has higher sensitivity, but it is limited by cost, invasiveness, and expertise availability [ 6 ]. Many noninvasive biomarkers including tumor markers are also reported in diagnosing MPE.…”

Section: Discussionmentioning

confidence: 99%

Use of Platelet Parameters in the Differential Diagnosis of Lung Adenocarcinoma-Associated Malignant Pleural Effusion and Tuberculous Pleural Effusion

et al. 2022

Disease Markers

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Background. Both malignant pleural effusion (MPE) and tuberculous pleural effusion (TPE) are common etiologies of pleural effusion; the present study was conducted to establish the diagnostic value of platelet parameters in the differential diagnosis of MPE and TPE. Methods. This retrospective study enrolled patients with lung adenocarcinoma-associated MPE and TPE. Platelet parameter data, including platelet count (PLT), mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), and platelet-larger cell ratio (P-LCR), were collected. Principal component analysis and multiple logistic regression modelling were carried out to assess the diagnostic value of these platelet parameters. Results. The MPE group and the TPE group enrolled 270 and 433 patients, respectively. Demographic characteristics of patients were more female and higher age in the MPE group. MPV, PDW, and P-LCR were significantly higher in MPE patients, while PLT and PCT were significantly higher in TPE patients. Principal component analysis generated two principal components (PCs) based on above platelet parameters. After adjusting for confounding factors including gender and age, multiple logistic regression showed positive association between PC1 and MPE. Conclusion. Platelet parameters were potential biomarkers in distinguishing lung adenocarcinoma-associated MPE from TPE. A patient with lower PLT and PCT and higher MPV, PDW, and P-LCR was more likely to be diagnosed as the former. Principal component analysis and multiple logistic regression performed well in improving multicollinearity, adjusting confounding factors, and identifying important risk factors for MPE.

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Section: Discussionmentioning

confidence: 99%

Use of Platelet Parameters in the Differential Diagnosis of Lung Adenocarcinoma-Associated Malignant Pleural Effusion and Tuberculous Pleural Effusion

et al. 2022

Disease Markers

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“…The incidence of lung cancer increases in women, and also due to the increasing age of the population. 1,2 The main symptoms of MPE are dyspnea, chest pain, and deterioration of the quality of life. Given that MPE is considered as a manifestation of terminal disease, the main goal of treatment is palliative, that is, to control and alleviate secondary symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…Other approaches such as indwelling pleural catheter (IPC) placement were traditionally reserved for patients ineligible for the former, for example, with trapped lung or in case of failure of pleurodesis. [1][2][3] However, in recent years, a number of randomized clinical trials and high-quality studies have shown IPC to be effective and similar to pleurodesis in terms of symptom control and improvement of the quality of life, and with significant benefits for patients such as ambulatory management and the need for fewer additional pleural procedures. [4][5][6] Recent systematic reviews comparing the effectiveness of IPC versus pleurodesis concluded that the two approaches share a similar success rate for the control of MPE.…”

Section: Introductionmentioning

confidence: 99%

Cost Effectiveness of Malignant Pleural Effusion with Indwelling Catheter: Systematic Review

Botana-Rial

Ramos-Hernández

Lojo-Rodríguez

et al. 2021

Journal of Palliative Medicine

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Background: The current cost of treatment of malignant pleural effusion (MPE) with an indwelling pleural catheter (IPC) is unclear.Objective: We propose a review of the scientific evidence on the cost and effectiveness of this therapeutic option. Methods: Systematic review of the literature on the cost and effectiveness of the treatment of MPE by IPC, according to the PRISMA methodology and quality according to the scientific guidelines. Results: A total of 4 articles, 152 patients, and 159 IPCs were included. The use of IPC was associated with improvement in symptoms and quality of life. The most common complications were infections (empyema in 20.9% of patients and cellulitis in 17.3%); 9% of cases were hospitalized due to complications, and <2% required subsequent procedures. The average cost of IPC (set/drainage bottles) ranged from e2,025.6 to e1,200.5 if it was placed on an outpatient basis, e1,100 if survival was <6 weeks, and e4,028 in patients with mesothelioma. Complications increased the cost, and taking into account follow-up visits, additional tests, and days of admission for complications, the cost was >e5,000. Compared with pleurodesis, the cost of IPC was significantly lower when patient survival was <14 weeks, but not when survival was longer or home care was required. Conclusions: The use of IPC is associated with good control of MPE and seldom requires many subsequent procedures; however, it is also associated with a certain rate of complications, which may increase costs. However, ambulatory management may help reduce costs, which are directly related to the type of tumor, the duration of survival, and the need for specialized treatment.

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“…The procedure is safe, well tolerated and can diagnose and stage patients with suspected lung cancer. The yield of initial thoracentesis for diagnosis of malignancy is about 65%, and subsequent thoracentesis increases the yield by 25% (5,6,8,9). After non-diagnostic thoracentesis, pleural biopsy is usually performed via medical pleuroscopy, video-assisted thoracoscopic surgery (VATS) or image guidance (10,11).…”

Section: Introductionmentioning

confidence: 99%

Pleural effusions associated with squamous cell lung carcinoma have a low diagnostic yield and a poor prognosis

Dorry¹,

Davidson²,

Dash³

et al. 2021

Transl Lung Cancer Res

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Background: Malignant pleural effusion (MPE) portends a poor prognosis in non-small cell lung cancer (NSCLC). However, the yield of pleural fluid cytology as well as survival of patients with MPE associated with squamous cell carcinoma versus adenocarcinoma is not well understood. We conducted this study to assess the diagnostic yield of pleural cytology and survival of patients with NSCLC related MPE.Methods: We performed a single-center, retrospective analysis of patients with NSCLC related MPE between 2010 and 2017. Kaplan-Meier method was used to compare survival and Cox proportional hazards analysis to assess if squamous cell cytopathology was associated with mortality.Results: We identified 277 patients, 29 with squamous cell and 248 with adenocarcinoma MPE. Pleural fluid cytology from initial thoracentesis was diagnostic in 13.8% (4/29) patients with squamous cell and 80.2% (199/248) with adenocarcinoma (P<0.001). Cytology from second thoracentesis was diagnostic in 13.3% (2/15) patients with squamous cell carcinoma, compared to 37.5% (12/32) with adenocarcinoma (P=0.17). There was no statistically significant difference in the pleural biopsy yield from medical pleuroscopy or video-assisted thoracoscopic surgery (VATS) in the two groups. The median survival of patients with squamous cell MPE was 112 (interquartile range, IQR: 44-220) days versus 194 (IQR: 54-523) days in adenocarcinoma (Log-rank test P=0.04). Multivariate Cox proportional hazards analysis showed that squamous cell cytopathology was independent predictor of mortality (hazard ratio for death of 1.73, 95% CI:1.1-2.6; P=0.01).Conclusions: Pleural fluid cytology has a low diagnostic yield in squamous cell carcinoma MPE, and these patients have a poor survival compared to lung adenocarcinoma.

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Contemporary Approach to the Diagnosis of Malignant Pleural Effusion

Cited by 24 publications

References 69 publications

Use of Platelet Parameters in the Differential Diagnosis of Lung Adenocarcinoma-Associated Malignant Pleural Effusion and Tuberculous Pleural Effusion

Use of Platelet Parameters in the Differential Diagnosis of Lung Adenocarcinoma-Associated Malignant Pleural Effusion and Tuberculous Pleural Effusion

Cost Effectiveness of Malignant Pleural Effusion with Indwelling Catheter: Systematic Review

Pleural effusions associated with squamous cell lung carcinoma have a low diagnostic yield and a poor prognosis

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