Diagnosis and management of malignant pleural effusions: state of the art in 2017

Desai, Neeraj R.; Lee, Hans J.

doi:10.21037/jtd.2017.07.79

Cited by 54 publications

(70 citation statements)

References 85 publications

(98 reference statements)

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“…Malignant Pleural Effusion (MPE) (13,14,15,16) In our study 4 cases of malignant pleural effusions were diagnosed. According to Neeraj R. Desai and Hans J.nee Malignant pleural effusion is a common complication of primary and secondary Malignancies of the lung with an incidence of over 1,50,000 cases out of which lung cancer, breast cancer and lymphomas were the most common causes.…”

Section: Nephrotic Syndromementioning

confidence: 94%

Study of Pleural Effusions in Patients Attending Katuri Medical College & Hospital, Chinakondrupadu, Guntur, Andhra Pradesh

Himaja¹,

Mandava²,

Somakrishna³

et al. 2019

jemds

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BACKGROUND Pleural effusion is a common complication of many disease processes. Disorders causing distortion in body fluid mechanics will cause either transudative effusions or exudative effusions. Lights criteria are used to differentiate Exudative from Transudative Effusions. The present study is undertaken to study the aetiology and clinical features of pleural effusion in our institute. Tuberculosis is still one of the most important causes of exudative plural effusion. The levels of Adenosine De Aminase an enzyme found in most cases are increased and its determination has proven to be useful as diagnostic test in case of TPE. Elevated plural fluid ADA predicts TB plural effusion with a sensitivity of 90-100% and specificity of 89-100%. METHODS 100 cases of pleural effusion admitted in Katuri Medical College were carefully studied, and investigated. Skiagram postero-anterior view of chest with both domes of diaphragm were done for all patients. Ultrasound chest-for estimating the quantity of fluid and site of aspiration was done in all cases and sent for pleural fluid ADA, counts, protein, sugar and LDH values. Pleural fluid cytology for malignant cells and gun biopsy of the malignant mass was done in 2 cases. Immunohistochemistry was done in both malignancies for TTF-1 and p40 for confirmation of squamous and adeno carcinomas respectively. RESULTS 100 cases of pleural effusion were studied in a 2-year period in the Department of Pulmonology, Katuri Medical College, Chinakondrupadu. Among 100 cases, 97 are exudates and 3 cases are transudates. Tuberculosis is the most common cause of exudative pleural effusion (91 cases). CONCLUSIONS Out of 100 cases of pleural effusion 97 cases were exudates and 3 were transudates. Tuberculosis was the most common cause of exudative pleural effusion. Malignancy was the second most common cause. Congestive cardiac failure was the most common cause of transudative pleural effusions. The estimation of pleural fluid differential counts was important for ruling out other causes. ADA is a reliable tool for diagnosis of tuberculosis when applied along with Light's criteria.

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Section: Nephrotic Syndromementioning

confidence: 94%

Study of Pleural Effusions in Patients Attending Katuri Medical College & Hospital, Chinakondrupadu, Guntur, Andhra Pradesh

Himaja¹,

Mandava²,

Somakrishna³

et al. 2019

jemds

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“…17 The sensitivity of thoracentesis for diagnosing malignancy with pleural fluid cytology is approximately 60%. 7 A second specimen increases the yield by 27%, but there is no further increase in diagnostic yield with more than 2 specimens. 18 When the diagnostic yield of pleural fluid cytology is low or nondiagnostic in a patient with suspected MPE, the next step is either a blind or image-guided pleural biopsy.…”

mentioning

confidence: 96%

“…Eighty percent of patients with MPE who present with dyspnea will demonstrate a moderate-to-large pleural effusion on chest x-ray, 10% will have a massive pleural effusion, and 10% will present with an MPE of <500 mL. 7 Ultrasound is more sensitive than chest radiography in the detection of pleural effusion and can be used to assess pleural thickness and to identify pleural metastases, which appear as small hypoechoic lenticular masses with obtuse margins within the chest wall or large masses with complex echogenicity. [7][8][9] In addition to its utility in diagnosing MPE, ultrasound (US) also is the standard of care to identify the appropriate site for drainage, reducing complication rates, 10,11 and a useful tool to assess lung reexpansion postdrainage and assess for complications such as a pneumothorax.…”

mentioning

confidence: 99%

“…Blind pleural biopsies have a lower sensitivity owing to lower earlier stage and tumor distribution but can improve the diagnostic sensitivity of pleural fluid cytology by 7% to 27%. 7 The complication rates are as high as 14.4%, with a 9.4% incidence of pneumothorax. 19 Blind pleural biopsy is performed in areas where the expertise or equipment for image-guided biopsies, pleuroscopy, or VATS are not available.…”

mentioning

confidence: 99%

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The Updated ATS/STS/STR Clinical Practice Guidelines on the Management of Malignant Pleural Effusions: What Is New in 2018?

Rakesh

Gelzinis

2019

Journal of Cardiothoracic and Vascular Anesthesia

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MALIGNANT PLEURAL effusion (MPE) is defined as the presence of malignant cells in the pleural fluid and when present is a sign of an advanced stage of either a thoracic or extrathoracic malignancy. MPE is suspected in patients with a history of advanced malignant disease who present with a recurrent pleural effusion that contains an elevated protein concentration with lymphocyte predominance. 1 MPE is a common complication, with an estimated incidence of >150,000 cases per year, with most arising from lung and breast cancer metastases, lymphoma, and gastrointestinal tumors, although MPE has been documented with most malignancies. 2 Once diagnosed, the median survival ranges from 4 to 7 months, depending on the type of malignancy, tumor characteristics, the extent of disease, comorbidities, and the composition of the MPE. 3 It is a very disabling condition, with a huge impact on quality of life. 1 Once diagnosed, the management goals for these patients include palliation and improving the patient's remaining quality of life. The challenge is predicting the individual's remaining life span. Studies using quality of life measures, such as the Karnofsky performance scale, have found that patients with low scores of <30 had a median survival of 1.1 months, whereas those with higher scores (>70) tended to have a longer median survival of 13.2 months. 3 Clive et al., using a simplified version of the Karnofsky scale known as the Eastern Cooperative Oncology Group (ECOG) scale, compared the use of this scale alone with the scale in conjunction with laboratory findings and tumor type and developed a score called the LENT score. 4 The components of the LENT score include lactate dehydrogenase levels in the pleural effusion, ECOG scale, the neutrophilto-lymphocyte ratio, and the tumor type. Those authors demonstrated that the LENT score was able to risk stratify patients into a low-risk group, with a median survival of 319 days; a moderate-risk group, with a mean survival of 130 days; and a high-risk group, with a mean survival of 44 days. The score also was found to be superior to the ECOG alone in predicting survival at 1, 3, and 6 months. 4

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“…Malignant pleural effusion (MPE) is a complication of different metastatic cancers and therefore a common clinical challenge [1]. Median survival following its diagnosis is usually less than 12 months and is dependent on the type of underlying malignancy, performance status, treatment, and the characteristics of serum and pleural effusion markers [2][3][4][5].…”

mentioning

confidence: 99%

Is the LENT Score Already Outdated?

Rozman

Mok

2018

Respiration

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Diagnosis and management of malignant pleural effusions: state of the art in 2017

Cited by 54 publications

References 85 publications

Study of Pleural Effusions in Patients Attending Katuri Medical College & Hospital, Chinakondrupadu, Guntur, Andhra Pradesh

Study of Pleural Effusions in Patients Attending Katuri Medical College & Hospital, Chinakondrupadu, Guntur, Andhra Pradesh

The Updated ATS/STS/STR Clinical Practice Guidelines on the Management of Malignant Pleural Effusions: What Is New in 2018?

Is the LENT Score Already Outdated?

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