Normativa sobre el diagnóstico y tratamiento del derrame pleural. Actualización

Garrido, Victoria Villena; Viedma, Enrique Cases; Villar, Alberto Fernández; Gafas, Alicia de Pablo; Rodríguez, Esteban Pérez; Pérez, José Manuel Porcel; Panadero, Francisco Rodríguez; Martínez, Carlos Ruiz; Velázquez, Ángel Salvatierra; Cuadrado, Luís Valdés

doi:10.1016/j.arbres.2014.01.016

Cited by 107 publications

(17 citation statements)

References 56 publications

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“…[2] MPE accounts for 15%–35% of all pleural effusions (PEs) of each series. [34] Its appearance is key for the prognosis of a cancer patient because median survival from diagnosis does not usually exceed 6 months. [56] This means a management shift from a curative approach to palliative care, directed more specifically toward the MPE, trying to control the symptoms associated with it.…”

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Pleural procedures in the management of malignant effusions

Ferreiro¹,

Suárez-Antelo

Valdés³

2017

Ann Thorac Med

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Malignant pleural effusion (MPE) is common in clinical practice, and despite the existence of studies to guide clinical decisions, it often poses diagnostic and therapeutic dilemmas. Once it is diagnosed, median survival does not usually exceed 6 months. The management of these patients focuses on symptom relief since no treatments have been shown to increase survival to date. Conversely, poor management can shorten survival. The approach must be multidisciplinary and allow for individualized care. Initial diagnostic procedures should be minimally invasive and, according to the results and other factors, procedures of increasing complexity will be selecting. Likewise, the treatment of MPEs should be individualized according to factors such as type of tumor, patient functional status, means available, benefits of each procedure, or life expectancy. Currently, treatment seems to tend toward less interventional approaches, in which patients can be managed on an outpatient basis, thus minimizing both the discomfort that more aggressive approaches involve and the costs of care associated with this disease. This article reviews the pleural procedures employed in the management of MPEs with special emphasis on the indication for each one, its usefulness, benefits, and complications.

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confidence: 99%

“…Throughout, we have followed the management algorithm recommended by the Spanish Society of Pneumology and Thoracic Surgery[4] [Figure 1]. …”

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Pleural procedures in the management of malignant effusions

Ferreiro¹,

Suárez-Antelo

Valdés³

2017

Ann Thorac Med

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“…El derrame pleural maligno representa hasta el 35 % de todos los derrames pleurales (5). Generalmente, supone un estadio avanzado de la enfermedad y se asocia a un mal pronóstico.…”

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“…Entre las exploraciones dirigidas al manejo paliativo del DPM, las toracocentesis repetidas, suponen una alternativa, sobre todo si el estado general del paciente es malo y su expectativa de vida limitada. Debido a la elevada recurrencia del DPM, en pacientes con un índice de Karnosfky mayor de 40 y una expectativa de vida superior al mes, la pleurodesis química representa una alternativa, siempre que se demuestre que el pulmón sea reexpansible tras la realización de una toracocentesis terapéutica (5). En los casos en los que la pleurodesis no pueda realizarse o haya fracasado, exista una falta de reexpansión pulmonar tras la evacuación del líquido pleural o en pacientes con corta expectativa de vida, el uso de catéteres tunelizados permanentes representa una alternativa con escasas complicaciones (6).…”

Section: Discussionunclassified

Manejo domiciliario del catéter pleural tunelizado permanente: A propósito de un caso

2020

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El derrame pleural maligno representa una entidad frecuente en pacientes con enfermedades neoplásicas. Su aparición representa un estadio avanzado de la enfermedad e indica mal pronóstico, y puede conllevar una elevada carga sintomática con el deterioro de la calidad de vida. Aunque su manejo debe individualizarse, en determinados casos, la utilización de catéteres pleurales tunelizados permanentes puede ser una alternativa segura y eficaz para intentar alcanzar un adecuado control de los síntomas.Presentamos el caso de una paciente diagnosticada en nuestro departamento de un mesotelioma pleural maligno con derrame pleural recidivante, a la que se le colocó un catéter pleural tunelizado puesto que los intentos previos de pleurodesis habían fracasado. Describimos el procedimiento, así como el manejo domiciliario. En este caso, se optó por un abordaje integral con apoyo domiciliario de la Unidad de Hospitalización a Domicilio de nuestro hospital.En definitiva, el catéter pleural permanente tunelizado representa una alternativa eficaz y segura en el manejo ambulatorio de los pacientes con derrame pleural maligno recidivante y sintomático. Este sistema permite la extracción de líquido pleural en el domicilio del paciente y alcanzar un mayor control de los síntomas respiratorios y una mayor calidad de vida en este grupo de pacientes.

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“…The definite diagnosis of MPE is determined by pleural fluid cytology, once or several times, or sometimes by pleural biopsy [1]. Although pleural fluid cytology is a simple method for diagnosis, its diagnostic yield is approximately 60% and depends on the underlying pathologic type of primary malignancy [1,4].…”

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confidence: 99%

Pro-cathepsin D as a diagnostic marker in differentiating malignant pleural effusion from benign pleural effusion: A retrospective cohort study

Choi¹,

Ko²,

Lee³

2020

Preprint

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Background Malignant pleural effusion (MPE) is a common complication of lung cancer and intrathoracic spreading or metastasis of extra-thoracic malignancy. The aim of the present study was to evaluate the levels of pro-cathepsin D from plasma and pleural fluid in patients with MPE and those in patients with benign pleural effusion (BPE) including pleural tuberculosis and parapneumonic effusion.Methods This study included 81 patients with pleural effusion who underwent thoracentesis and pleural biopsy. Pleural fluid and serum were collected as a standard procedure for all individuals at the same time. The level of pro-cathepsin D was measured by the sandwich enzyme-linked immunosorbent assay method.Results Though there were no significant differences in plasma pro-cathepsin D between the two groups, the level of pleural fluid pro-cathepsin D was signiﬁcantly higher in the MPE group than the BPE group (0.651 versus 0.590 pg/mL, P = 0.034) (Table 1). In addition, there were no differences in pleural fluid pro-cathepsin D level according to causative malignancy of MPE. On receiver operating characteristic curve analysis, the optimal discrimination point between the MPE group and BPE group was deﬁned as a cut-off value of 0.5960 pg/mL for pleural fluid pro-cathepsin D (81.0% sensitivity; 53.0% speciﬁcity) and 0.4335 pg/mL for plasma pro-cathepsin D (71.4% sensitivity; 61.7% speciﬁcity).Conclusions We found that the level of pleural fluid pro-cathepsin D was significantly higher in the MPE group than the BPE group. Pro-cathepsin D could be a novel and potential biomarker to discriminate MPE from BPE.

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Normativa sobre el diagnóstico y tratamiento del derrame pleural. Actualización

Cited by 107 publications

References 56 publications

Pleural procedures in the management of malignant effusions

Pleural procedures in the management of malignant effusions

Manejo domiciliario del catéter pleural tunelizado permanente: A propósito de un caso

Pro-cathepsin D as a diagnostic marker in differentiating malignant pleural effusion from benign pleural effusion: A retrospective cohort study

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