Malignant pleural effusion


Malignant pleural effusion is a condition in which cancer causes an abnormal amount of fluid to collect between the thin layers of tissue pleura lining the outside of the lung and the wall of the chest cavity Lung cancer and breast cancer account for about 50-65% of malignant pleural effusions1 Other common causes include pleural mesothelioma and lymphoma

Contents

  • 1 Diagnosis
    • 11 Clinical evaluation
    • 12 Imaging
    • 13 Biochemical analysis
    • 14 Histopathology
    • 15 Biomarkers
  • 2 Treatment
  • 3 References
  • 4 External links

Diagnosisedit

Clinical evaluationedit

Clinical factors predicting the diagnosis of malignant pleural effusions are symptoms lasting more than 1 month and the absence of fever2

Imagingedit

This is needed to confirm the presence of a pleural effusion 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 fluid34

Biochemical analysisedit

Malignant pleural effusions are exudates A low pleural fluid pH is associated with poorer survival and reduced pleurodesis efficacy56

Histopathologyedit

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%7

Biomarkersedit

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 antigen891011 Pleural fluid mesothelin has a sensitivity of 71%, greater than that of cytology, and a specificity of 89% for the diagnosis of malignant mesothelioma12

Treatmentedit

The goal of treatment of malignant pleural effusions is relief of breathlessness13 Occasionally, treatment of the underlying cancer can cause resolution of the effusion This may be the case with types of cancer that respond well to chemotherapy, such as small cell carcinoma or lymphoma Simple aspiration of pleural fluid can relieve breathlessness rapidly but fluid and symptoms will usually recur within a couple of weeks For this reason, more permanent treatments are usually used to prevent fluid recurrence Standard treatment involves chest tube insertion and pleurodesis However, this treatment requires an inpatient stay of approximately 2–7 days, can be painful and has a significant failure rate This has led to the development of tunneled pleural catheters eg, Pleurx Catheters, which allow outpatient treatment of effusions

Referencesedit

 This article incorporates public domain material from the US National Cancer Institute document "Dictionary of Cancer Terms"

  1. ^ Antony VB, Loddenkemper R, Astoul P, et al August 2001 "Management of malignant pleural effusions" Eur Respir J 18 2: 402–19 PMID 11529302 doi:101183/090319360100225601 
  2. ^ Ferrer J, Roldán J, Teixidor J, Pallisa E, Gich I, Morell F March 2005 "Predictors of pleural malignancy in patients with pleural effusion undergoing thoracoscopy" Chest 127 3: 1017–22 PMID 15764788 doi:101378/chest12731017 
  3. ^ Qureshi NR, Rahman NM, Gleeson FV February 2009 "Thoracic ultrasound in the diagnosis of malignant pleural effusion" Thorax 64 2: 139–43 PMID 18852159 doi:101136/thx2008100545 
  4. ^ Chian CF, Su WL, Soh LH, Yan HC, Perng WC, Wu CP July 2004 "Echogenic swirling pattern as a predictor of malignant pleural effusions in patients with malignancies" Chest 126 1: 129–34 PMID 15249453 doi:101378/chest1261129 
  5. ^ Sahn SA, Good JT March 1988 "Pleural fluid pH in malignant effusions Diagnostic, prognostic, and therapeutic implications" Ann Intern Med 108 3: 345–9 PMID 3341671 doi:107326/0003-4819-108-3-345 
  6. ^ Rodríguez-Panadero F, López Mejías J March 1989 "Low glucose and pH levels in malignant pleural effusions Diagnostic significance and prognostic value in respect to pleurodesis" Am Rev Respir Dis 139 3: 663–7 PMID 2923367 doi:101164/ajrccm/1393663 
  7. ^ Maskell NA, Gleeson FV, Davies RJ April 2003 "Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of malignant disease in pleural effusions: a randomised controlled trial" Lancet 361 9366: 1326–30 PMID 12711467 doi:101016/S0140-67360313079-6 
  8. ^ Sack U, Hoffmann M, Zhao XJ, et al April 2005 "Vascular endothelial growth factor in pleural effusions of different origin" Eur Respir J 25 4: 600–4 PMID 15802331 doi:101183/090319360500037004 
  9. ^ Sumi M, Kagohashi K, Satoh H, Ishikawa H, Funayama Y, Sekizawa K 2003 "Endostatin levels in exudative pleural effusions" Lung 181 6: 329–34 PMID 14749937 doi:101007/s00408-003-1035-9 
  10. ^ Gaspar MJ, De Miguel J, García Díaz JD, Díez M 2008 "Clinical utility of a combination of tumour markers in the diagnosis of malignant pleural effusions" Anticancer Res 28 5B: 2947–52 PMID 19031938 
  11. ^ Vatansever S, Gelisgen R, Uzun H, Yurt S, Kosar F 2009 "Potential role of matrix metalloproteinase-2,-9 and tissue inhibitors of metalloproteinase-1,-2 in exudative pleural effusions" Clin Invest Med 32 4: E293–300 PMID 19640333 
  12. ^ Davies HE, Sadler RS, Bielsa S, et al September 2009 "Clinical impact and reliability of pleural fluid mesothelin in undiagnosed pleural effusions" Am J Respir Crit Care Med 180 5: 437–44 PMID 19299498 doi:101164/rccm200811-1729OC 
  13. ^ Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ August 2010 "Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010" Thorax 65 Suppl 2: ii32–40 PMID 20696691 doi:101136/thx2010136994 

External linksedit

  • Malignant pleural effusion entry in the public domain NCI Dictionary of Cancer Terms


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