Malignant Pleural Effusion and Its Current Management: A Review

Abstract

Malignant pleural effusion (MPE) is an exudative effusion with malignant cells. MPE is a common symptom and accompanying manifestation of metastatic disease. It affects up to 15% of all patients with cancer and is the most common in lung, breast cancer, lymphoma, gynecological malignancies and malignant mesothelioma. In the last year, many studies were performed focusing on the pathophysiological mechanisms of MPE. With the advancement in molecular techniques, the importance of tumor-host cell interactions is becoming more apparent. Additionally, the process of pathogenesis is greatly affected by activating mutations of EGFR, KRAS, PIK3CA, BRAF, MET, EML4/ALK and RET, which correlate with an increased incidence of MPE. Considering all these changes, the authors aim to present a literature review of the newest findings, review of the guidelines and pathophysiological novelties in this field. Review of the just recently, after seven years published, practice guidelines, as well as analysis of more than 70 articles from the Pubmed, Medline databases that were almost exclusively published in indexed journals in the last few years, have relevance and contribute to the better understanding of the presented topic. MPE still presents a severe medical condition in patients with advanced malignancy. Recent findings in the field of pathophysiological mechanisms of MPE emphasize the role of molecular factors and mutations in the dynamics of the disease and its prognosis. Treatment guidelines offer a patient-centric approach with the use of new scoring systems, an out of hospital approach and ultrasound. The current guidelines address multiple areas of interest bring novelties in the form of validated prediction tools and can, based on evidence, improve patient outcomes. However, the role of biomarkers in a clinical setting, possible new treatment modalities and certain specific situations still present a challenge for new research.

Cytohistological correlation in serous effusions using the newly proposed International System for Reporting Serous Fluid Cytopathology: Experience of an oncological center

“…Only two cases had insufficient material for analysis, reinforcing the advantage of liquid‐based preparations, which provide additional material for these tests, without compromising DNA viability or affecting test results 2 . Often, in a metastatic context, cytology specimens are the only tumor samples available for researching these genetic alterations 30,31 …”

Multigene PCR using both cfDNA and cfRNA in the supernatant of pleural effusion achieves accurate and rapid detection of mutations and fusions of driver genes in patients with advanced NSCLC

“…Tumor cells in patients with advanced lung cancer infiltrate pleural cavity via the hematogenous, direct, or lymphatic spread, resulting impaired lymphatic drainage and pleural effusion accumulation. 24 Cytological examination of pleural effusion showed that 95% of malignant serous effusions represented metastatic disease, mainly composed of adenocarcinomas (70%-77%). 25 In this study, 88.3% of the enrolled patients with lung adenocarcinoma and 81.8% of the patients with local or distant metastases, two characteristics that were similar to those reported in the literature.…”

“…26 Molecular testing based on pleural effusion cytology specimens has been widely recommended in clinical guidelines of NSCLC and has become a routine method used in clinical practice. 24,27,28 The mutation detection rates based on this kind of specimens are affected by tumor content. 21,22 Previous studies showed that pleural effusion supernatants contain more abundant tumor derived DNA (ctDNA) than pleural effusion sediments and plasma samples, and had higher detection rate of EGFR driver mutations especially for detection of T790M in EGFR-TKI relapsed patients.…”

“…Molecular testing based on pleural effusion cytology specimens has been widely recommended in clinical guidelines of NSCLC and has become a routine method used in clinical practice 24,27,28 . The mutation detection rates based on this kind of specimens are affected by tumor content 21,22 .…”

Analysis of the effect of infection prevention nursing on drainage of malignant pleural effusion with indwelling central venous catheter

“…Malignant pleural effusion (MPE) is a type of pleural effusion characterized by the transfer of malignant cells to the pleura or other causes of pleural effusion (1). MPE is a common complication of malignant tumors, with an incidence of 15% in cancer patients (2,3), which usually indicates that the disease has reached the advanced stage, and is associated with high morbidity and mortality, along with reduced treatment options. MPE is most commonly found in lung cancer, followed by breast cancer (4), with the common symptoms being dyspnea, cough, and chest pain.…”