Malignant pleural effusion: Updates in diagnosis, management and current challenges

Abstract

Malignant pleural effusion (MPE) is a common condition which often causes significant symptoms to patients and costs to healthcare systems. Over the past decade, the management of MPE has progressed enormously with large scale, randomised trials answering key questions regarding optimal diagnostic strategies and effective management strategies. Despite a number of management options, including talc pleurodesis, indwelling pleural catheters and combinations of the two, treatment for MPE remains symptom directed and centered around drainage strategy. The future goals for providing improved care for patients lies in changing the treatment paradigm from a generic pathway to personalised care, based on probability of malignancy type and survival. This article reviews the current evidence base, new discoveries and future directions in the diagnosis and management of MPE.

Comparative Evaluation of Chest Ultrasonography and Computed Tomography as Predictors of Malignant Pleural Effusion: A Prospective Study

“…While the presence of liver metastasis can be an important finding in the evaluation of MPE, especially in cases of metastatic disease, the relatively low detection rates in this study may be due to the specific patient population or the limited field of view of both imaging techniques. Wholebody imaging modalities, such as positron emission tomography-computed tomography (PET-CT) or magnetic resonance imaging (MRI), may be more suitable for detecting distant metastases in patients with MPE [7,37].…”

“…In recent years, noninvasive imaging modalities such as ultrasonography (US) and computed tomography (CT) have become increasingly important in evaluating pleural effusions and diagnosing MPE. These modalities can provide valuable information about the nature and characteristics of pleural effusion, potentially guiding clinical decision making and reducing the need for invasive procedures [7][8][9].…”

“…The choice between chest US and chest CT as predictors of MPE depends on several factors, such as the clinical context, resource availability, and the specific information needed for patient management [7,19]. Although both US and CT have been extensively studied for their diagnostic utility in evaluating pleural effusions, there is still ongoing debate regarding their relative predictive value in determining the malignant nature of the effusions.…”

Management des malignen Pleuraergusses

“…metastasensuspekten Läsionen (wichtig bspw. für die Planung einer videoassistierten Thorakoskopie [VATS]) [9]. Diese Veränderungen lassen sich auch in der Fusionsbildgebung (Fluordesoxyglukose-Positronenemissionstomografie/Computertomografie [FDG-PET/CT]) nachweisen (Spezifität 74 %, Sensitivität 81 %), die jedoch nicht Bestandteil der Routinediagnostik ist.…”

Deep Learning-Based Classification and Targeted Gene Alteration Prediction from Pleural Effusion Cell Block Whole-Slide Images

“…With the gradual increase in treatment methods and the emergence of cell block technology, clinical cytologists are required not only to distinguish benign and malignant pleural effusions but also to identify the primary location of metastatic carcinomas or mutant genes using auxiliary methods such as immunohistochemistry or molecular detection [4,5]. However, due to the subjective and regionally dependent diagnostic level of cytopathologists, there is a problem of low consistency in the diagnosis of benign and malignant pleural 2 of 15 effusions [3,6]. In addition, malignant pleural effusions have not yet been recognized as routine substrates for the immunohistochemical or molecular testing pipeline due to their occasionally low tumor fraction and sparse cellularity [7][8][9].…”