Management of the Patient with a Malignant Pleural Effusion

Heffner, John E.

doi:10.1055/s-0030-1269831

Cited by 28 publications

(17 citation statements)

References 107 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this case, pleural biopsy or thoracoscopic surgery will normally be indicated for more accurate evaluation of malignant pleural involvement and metastasis. However, these invasive approaches require general anesthesia and may induce significant patient morbidity and increased health care costs and, thus, sometimes are not a good option for patients with advanced-stage disease (23).…”

Section: Discussionmentioning

confidence: 99%

High-throughput screening of rare metabolically active tumor cells in pleural effusion and peripheral blood of lung cancer patients

Tang

Wang

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

View full text Add to dashboard Cite

Malignant pleural effusion (MPE), the presence of malignant cells in pleural fluid, is often the first sign of many cancers and occurs in patients with metastatic malignancies. Accurate detection of tumor cells in pleural fluid is crucial because the presence of MPE denotes an advanced stage of disease and directs a switch in clinical managements. Cytology, as a traditional diagnostic tool, has limited sensitivity especially when tumor cells are not abundant, and may be confounded by reactive mesothelial cells in the pleural fluid. We describe a highly sensitive approach for rapid detection of metabolically active tumor cells in MPE via exploiting the altered glucose metabolism of tumor cells relative to benign cells. Metabolically active tumor cells with high glucose uptake, as evaluated by a fluorescent glucose analog (2-NBDG), are identified by high-throughput fluorescence screening within a chip containing 200,000 addressable microwells and collected for malignancy confirmation via single-cell sequencing. We demonstrate the utility of this approach through analyzing MPE from a cohort of lung cancer patients. Most candidate tumor cells identified are confirmed to harbor the same driver oncogenes as their primary lesions. In some patients, emergence of secondary mutations that mediate acquired resistance to ongoing targeted therapies is also detected before resistance is manifested in the clinical imaging. The detection scheme can be extended to analyze peripheral blood samples. Our approach may serve as a valuable complement to cytology in MPE diagnosis, helping identify the driver oncogenes and resistance-leading mutations for targeted therapies.

show abstract

Section: Discussionmentioning

confidence: 99%

High-throughput screening of rare metabolically active tumor cells in pleural effusion and peripheral blood of lung cancer patients

Tang

Wang

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

View full text Add to dashboard Cite

show abstract

“…The production of MPE is a pathological process, which results from the failure of pleural defense mechanisms and abnormal mesothelial function, and it is defined by the presence of tumor cells in the pleural effusion [18]. Pulmonary carcinoma is one of the main causes of MPE [19,20].…”

Section: Discussionmentioning

confidence: 99%

Superiority and clinical significance of Lunx mRNA in the diagnosis of malignant pleural effusion caused by pulmonary carcinoma

Tang

2013

J Exp Clin Cancer Res

View full text Add to dashboard Cite

BackgroundPulmonary carcinoma is the main cause of malignant pleural effusions (MPEs). However, there is no satisfactory marker for diagnosing MPEs caused by pulmonary carcinoma. The purpose of this study is to assess the clinical significance of Lunx mRNA detection in diagnosing MPEs caused by pulmonary carcinoma.MethodsA total of 209 patients with pleural effusions were recruited. The patients were diagnosed by cast-off cells, bronchoscopy, and pleural biopsy. The levels of Lunx mRNA in the pleural effusions were determined by real-time PCR. The levels of PH, LDH, glucose, albumin, and CEA were also determined. Patients who accepted chemotherapy underwent Lunx mRNA detection before and after the first chemotherapy session. The patients were divided into four groups according the effect of chemotherapy: complete remission (CR), partial remission (PR), no change (NC), and progressive disease (PD). The patients were also divided into two groups according the change in direction of Lunx mRNA expression after chemotherapy: increased group and decreased group. The patients were followed up to determine survival.ResultsLunx mRNA was positive in 89 of 106 patients with pleural effusions caused by pulmonary carcinoma. The specificity and sensitivity were 95.9% and 84.9%. The area under the ROC curve was 0.922. Lunx mRNA detection was better than detection using cast-off cells and CEA. All of the Lunx-positive patients with MPEs were diagnosed with pulmonary carcinoma, and all extrapulmonary carcinoma patients were Lunx-negative. The positive predictive value of Lunx mRNA for the source of tumor cells was 100%. Lunx mRNA expression decreased after the first session of chemotherapy in the CR and PR groups, increased in the PD group, there was no change in the NC group. Further analysis indicated the change in direction of Lunx mRNA expression was associated with the overall survival of patients. The patients in the increased group had longer overall survival times than those in the decreased group.ConclusionLunx mRNA is a specific tumor gene that is highly expressed in MPEs caused by pulmonary carcinoma. The changes in Lunx mRNA levels after chemotherapy can predict the prognosis of patients with MPEs caused by pulmonary carcinoma.

show abstract

“…Plevral sıvı pH'ı ne kadar düşük ise plöredezisin başarılı olma şansı o kadar azdır. pH 7.30'un üzerinde ise başarı olasılığı %90'dan fazla iken pH 7.15'in altında olduğunda başarı olasılığı %50'nin altındadır (30) (24,31) . Plöredezis için birçok kemoterapötik ve diğer kimyasal ajanlar değişen başarı oranları ile uygulanmaktadır.…”

Section: Tedaviunclassified

Emergencies in Lung Cancer

Gümüş¹,

Özyurt²

2018

GGHS

View full text Add to dashboard Cite

İnsanlarda beklenen ortalama yaşam süresinin artmasıyla birlikte kanser vakalarında da artışlar görülmektedir. Özellikle akciğer kanserinin görülme sıklığı ve mortalitesi dünya çapında artmaya devam etmektedir. Bu hastalarda sıklıkla akut ciddi semptomlar ve yaşamı tehdit eden durumlar ortaya çıkmakta ve acil tıbbi bakım gerekmektedir. Akciğer kanserinde acil servise başvuru ve mortalite diğer solit tümörlerden daha fazla görülmektedir. Bu acil durumlar kanserle direkt veya dolaylı olarak ya da tümörün tedavisi ile ortaya çıkar ve potansiyel olarak yaşamı tehdit eder. Tümörün bölgesel yayılımı ilişkili olarak vena kava süperior sendromu, perikardiyal tamponat, masif hemoptizi, massif plevral efüzyon ve akut hava yolu obstrüksiyonu görülmektedir. Hiperkalsemi, hiponatremi, uygunsuz ADH salınımı sendromu ve tümör lizis sendromu ise akciğer kanserinde ortaya çıkan metabolik acil durumlardır. Beyin metastazları, kemik metastazları ve spinal kord basısı uzak metastazlara bağlı olarak ortaya çıkmaktadır. Ayrıca, bu hastalarda kemoterapiye bağlı olarak febril nötropeni, hipersensitivite reaksiyonları ve anaflaksi, radyoterapiye bağlı olarak akut radyasyon pnömonitisi ve özefajit ortaya çıkmaktadır. Onkolojik aciller hayatı tehtit eder ve mortalitesi yüksektir. Mortalite ve morbiditeyi azaltmak için erken tanı ve tedavi büyük önem taşır. Çünkü tanı ve tedavide gecikmeler çoğu zaman ölümle sonuçlanabilmektedir.

show abstract

Management of the Patient with a Malignant Pleural Effusion

Cited by 28 publications

References 107 publications

High-throughput screening of rare metabolically active tumor cells in pleural effusion and peripheral blood of lung cancer patients

High-throughput screening of rare metabolically active tumor cells in pleural effusion and peripheral blood of lung cancer patients

Superiority and clinical significance of Lunx mRNA in the diagnosis of malignant pleural effusion caused by pulmonary carcinoma

Emergencies in Lung Cancer

Contact Info

Product

Resources

About