Investigation and outcomes in patients with nonspecific pleuritis: results from the International Collaborative Effusion database

Abstract

IntroductionWe present findings from the International Collaborative Effusion database, an ERS clinical research collaboration. Non-specific pleuritis (NSP) is a broad term that describes chronic pleural inflammation. Various aetiologies lead to NSP, which poses a diagnostic challenge for clinicians. A significant proportion of patients with this finding eventually develop a malignant diagnosis.Methods12 sites across 9 countries contributed anonymised data on 187 patients. 175 records were suitable for analysis.ResultsThe commonest aetiology for NSP was recorded as Idiopathic (80/175, 44%). This was followed by pleural infection (15%), benign asbestos disease (12%), malignancy (6%) and cardiac failure (6%). The malignant diagnoses were predominantly mesothelioma (6/175, 3.4%) and lung adenocarcinoma (4/175, 2.3%). The median time to malignant diagnosis was 12.2 months (range 0.8–32). There was a signal towards greater asbestos exposure in the malignant NSP group compared to the benign group (0.63versus0.27, p=0.07). Recurrence of effusion requiring further therapeutic intervention, nor initial biopsy approach were associated with a false negative biopsy. A computed tomography finding of a mass lesion was the only imaging feature to demonstrate a significant association (0.18versus0.01, p=0.02), though sonographic pleural thickening also suggested an association (0.27versus0.09, p= 0.09).DiscussionThis is the first multi-centre study of NSP and its associated outcomes. Whilst some of our findings are reflected by the established body of literature, other findings have highlighted important areas for future research, not previously studied in NSP.

Diagnostic value and safety of medical thoracoscopy in undiagnosed pleural effusions—a prospective observational cohort study

“…Hence, this is unlikely to significantly impact on our reported diagnostic accuracy. What is unique about our patient cohort is the relatively low rate (10.6%) of non-specific pleuritis compared to a mean incidence of 40% in other studies ( 24 ). This may be a reflection of our centre’s selection of patients, where thoracoscopy is offered for cases with a higher pre-test probability of MPE.…”

“…Only three patients had a diagnosis of idiopathic non-specific pleuritis, two patients had a minimum follow-up period of 12 and 15 months revealing no re-accumulation of pleural effusion, and one patient had passed away from pneumonia at 4 months. Studies describe 3–12% of patients with non-specific pleuritis being diagnosed to have cancer (most commonly mesothelioma) at a median follow-up time between 9–12 months ( 24 - 26 ). Hence, this is unlikely to significantly impact on our reported diagnostic accuracy.…”

Use of medical thoracoscopy in managing pleural malignancy

“…The latest retrospective case series in the literature summarised the outcomes of 175 patients with NSP from various international centres. 6% of patients developed a malignancy after a median time of 12 months, expert opinion suggests that patients with NSP should be followed up for at least 24 months and undergo with regular imaging [ 21 ]. An ongoing observational trial is in progress looking at the evolution of NSP in patients previously exposed to asbestos, which should provide robust prospective data [ 22 ].…”