Malignant pleural effusion

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Malignant pleural effusion
SpecialtyOncology Edit this on Wikidata

Malignant pleural effusion is a condition in which

pleural mesothelioma and lymphoma
.

Diagnosis

Clinical evaluation

Clinical factors predicting the diagnosis of malignant pleural effusions are symptoms lasting more than 1 month and the absence of fever.[4]

Imaging

Imaging is needed to confirm the presence of a pleural effusion. A Chest radiograph is usually performed first and may demonstrate an underlying lung cancer as well as the pleural effusion. Ultrasound has a sensitivity of 73% and specificity of 100% at distinguishing malignant pleural effusions from other causes of pleural effusion, based on the presence of visible pleural metastases, pleural thickening greater than 1 cm, pleural nodularity, diaphragmatic thickening measuring greater than 7mm and an echogenic swirling pattern visible in the pleural fluid.[5][6]

Biochemical analysis

Malignant pleural effusions are

exudates. A low pleural fluid pH is associated with poorer survival and reduced pleurodesis efficacy.[7][8]

Histopathology

Pleural fluid cytology is positive in 60% of cases. However, in the remaining cases, pleural biopsy is required. Image guided biopsy and thoracoscopy have largely replaced blind biopsy due to their greater sensitivity and safety profile. CT guided biopsy has a sensitivity of 87% compared to Abrams' needle biopsy, which has a sensitivity of 47%.[9]

Biomarkers

Identification of pleural fluid biomarkers to distinguish malignant pleural effusions from other causes of exudative effusions would help diagnosis. Biomarkers that have been shown to be raised in malignant pleural effusions compared to benign disease include vascular endothelial growth factor (VEGF), endostatin, matrix metalloproteinases and tumour markers such as carcinoembryonic antigen.[10][11][12][13] Pleural fluid mesothelin has a sensitivity of 71%, greater than that of cytology, and a specificity of 89% for the diagnosis of malignant mesothelioma.[14]

Treatment

The goal of treatment of malignant pleural effusions is relief of shortness of breath.

small cell carcinoma or lymphoma. Simple aspiration of pleural fluid can relieve shortness of breath rapidly but fluid and symptoms will usually recur within a couple of weeks. Drainage should generally be done under ultrasound guidance.[16]

For this reason, more permanent treatments are usually used to prevent fluid recurrence. Standard treatment involves inserting an indwelling pleural catheter and

Pleurx Catheters), which allow outpatient treatment of effusions. If an infection due to the catheter occurs, antibiotics are given and the catheter is generally left in.[16]

A Cochrane review concluded tentatively in favour of thoracoscopy to remove the fluid and blow talc into the pleural cavity (talc poudrage) compared to other commonly used methods. [17]

References

  1. ^ "NCI Dictionary of Cancer Terms". NCI. 2011-02-02. Retrieved 21 December 2018.
  2. PMID 2579439
    .
  3. PMID 11529302
    .
  4. PMID 15764788
    .
  5. PMID 18852159
    .
  6. PMID 15249453
    .
  7. PMID 3341671
    .
  8. PMID 2923367
    .
  9. S2CID 22606449
    .
  10. PMID 15802331
    .
  11. S2CID 10290685
    .
  12. PMID 19031938
    .
  13. PMID 19640333
    .
  14. PMID 19299498
    .
  15. PMID 20696691
    .
  16. ^
    S2CID 52894157
    .
  17. PMID 32315458
    .

Public Domain This article incorporates

U.S. National Cancer Institute
.

External links

Retrieved from "https://en.wikipedia.org/w/index.php?title=Malignant_pleural_effusion&oldid=1218180057"