Diagnostic and Prognostic Implications of Pleural Adhesions in Malignant Effusions

Bielsa, Silvia; Martín-Juan, José; Porcel, José M.; Rodríguez-Panadero, Francisco

doi:10.1097/jto.0b013e318189f53d

Cited by 45 publications

(40 citation statements)

References 19 publications

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“…Intrapleural adhesions and septated effusions remain a common and burdensome clinical entity. The presence of adhesions carries a poor prognostic factor in patients with exudative pleural effusions and may render the pleural fluid drainage difficulty [2]. In dealing with this problem, intrapleural fibrinolytics may be a safe, easy, cost effective management option.…”

Section: Introductionmentioning

confidence: 97%

Using streptokinase for pleural adhesiolysis in sonographically septated pleural effusion

Omar

Elfadl

Ahmed

et al. 2015

Egyptian Journal of Chest Diseases and Tuberculosis

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Background: In dealing with septated pleural effusion, intrapleural fibrinolytics may be a useful alternative for others such as use of video assisted thoracic surgery or the conventional thoracotomy. The use of intrapleural fibrinolytics may be a safer, easier and cost effective management option that can promote pleural fluid drainage.Objective: To evaluate the role of intrapleural streptokinase as a fibrinolytic agent in the management of pleural effusion with adhesions.

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Section: Introductionmentioning

confidence: 97%

Using streptokinase for pleural adhesiolysis in sonographically septated pleural effusion

Omar

Elfadl

Ahmed

et al. 2015

Egyptian Journal of Chest Diseases and Tuberculosis

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“…Series examining the diagnostic rate for malignancy of pleural cytology have reported a mean sensitivity of about 60% (range 40-87%) [25,32]. Sensitivity of pleural effusion cytology is reduced to 20% in case of severe pleural adhesion [33]. Definitive diagnosis based on cytology alone is not recommended because of the high risk of diagnostic error [14,18].…”

Section: Concepts Of Early Mpm and Mesothelioma In Situmentioning

confidence: 95%

Practical approaches to diagnose and treat for T0 malignant pleural mesothelioma: a proposal for diagnostic total parietal pleurectomy

et al. 2012

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Malignant pleural mesothelioma (MPM) remains suffering poor prognosis in spite of recent diagnostic and therapeutic progress. Although there is currently no established evidence, early diagnosis and early intervention may play a key role to improve prognosis of MPM, similarly to other malignancies. As pleural effusion is usually the first clinical sign of MPM, pleural effusion cytology is often the first diagnostic examination to be carried out. Since the sensitivity of pleural effusion cytology is approximately 60%, however, false-negative diagnosis is given to almost half of true MPM patients at this clinical step. One practical way to reduce the number of misdiagnosed MPM is to encourage performing thoracoscopic pleural biopsy unless definitive diagnosis other than MPM is established. There still remain a considerable number of patients with radiological/thoracoscopic T0 MPM who are misdiagnosed with nonspecific pleuritis after a complete investigation including thoracoscopic biopsies. Such patients will turn out to be malignant during follow-up period, although they have the best opportunity for long-term survival if only early therapeutic intervention is given. Currently, we are performing diagnostic total parietal pleurectomy in highly selected patients, who are characterized with strong clinical suspicion, positive pleural effusion cytology but uncertain pathological diagnosis, excellent cardiopulmonary reserve, and with written informed consent for highly invasive diagnostic surgery for pathologically unproven disease.

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“…Medical thoracoscopy has a diagnostic yield of 85-100% for malignancy [48,49]. In addition, assessment of the extent of pleural adhesions during thoracoscopy provides prognostic information in patients with MPEs, with patients with minimal or no adhesions having a medial survival of 9 months compared with the 5 months achieved in those with high levels of adhesions [50]. Complications include empyema and pleural bleeding, however, mortality is extremely low.…”

Section: Pleural Biopsymentioning

confidence: 98%

Advances in the investigation and treatment of pleural effusions

Mishra¹,

Davies²

2010

Expert Review of Respiratory Medicine

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Pleural effusions present a challenge for both diagnosis and treatment. They are a commonly presenting problem of a wide range of local and systemic potentially life threatening diseases and cause significant breathlessness. Significant advances have been made in the last 5 years in the diagnostic pathway and management options. This article reviews recent developments in the investigation of pleural effusions, particularly in pleural fluid analysis, biomarkers, imaging and pleural biopsy, and in the treatment of pleural infection and both malignant and benign effusions, including the use of indwelling pleural catheters. Although significant recent advances have been made in the management of pleural effusions, there the need still remains for further research if we are to reduce the morbidity and mortality caused by pleural effusions.

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Diagnostic and Prognostic Implications of Pleural Adhesions in Malignant Effusions

Abstract: MPE are often loculated. The higher the grade of pleural adhesions, the greater the tumor burden exists, and paradoxically the lower the PF cytologic yield. The presence of pleural adhesions in MPE implies a poor prognosis.

Cited by 45 publications

References 19 publications

Using streptokinase for pleural adhesiolysis in sonographically septated pleural effusion

Using streptokinase for pleural adhesiolysis in sonographically septated pleural effusion

Practical approaches to diagnose and treat for T0 malignant pleural mesothelioma: a proposal for diagnostic total parietal pleurectomy

Advances in the investigation and treatment of pleural effusions

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