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Botana-Rial M, Lojo-Rodríguez I, Ramos-Hernández C, González-Piñeiro A, Núñez-Delgado M, Fernández-Villar A. Diagnostic Yield and Safety of Ultrasound-Assisted Pleural Biopsy (UAPB) in Pleural Effusion: A Life-Real Study. Arch Bronconeumol 2024:S0300-2896(24)00083-8. [PMID: 38641436 DOI: 10.1016/j.arbres.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Maribel Botana-Rial
- Broncopleural Unit, Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI, Vigo, Spain; PneumoVigoI+i Research Group, Sanitary Research Institute Galicia Sur (IISGS), Vigo, Spain; CIBERES-ISCIII, Spain.
| | - Irene Lojo-Rodríguez
- Broncopleural Unit, Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI, Vigo, Spain
| | - Cristina Ramos-Hernández
- Broncopleural Unit, Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI, Vigo, Spain; PneumoVigoI+i Research Group, Sanitary Research Institute Galicia Sur (IISGS), Vigo, Spain
| | | | - Manuel Núñez-Delgado
- Broncopleural Unit, Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI, Vigo, Spain; PneumoVigoI+i Research Group, Sanitary Research Institute Galicia Sur (IISGS), Vigo, Spain
| | - Alberto Fernández-Villar
- Broncopleural Unit, Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI, Vigo, Spain; PneumoVigoI+i Research Group, Sanitary Research Institute Galicia Sur (IISGS), Vigo, Spain; CIBERES-ISCIII, Spain
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2
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Metintas M, Ak G, Yildirim H, Dundar E, Aydin N, Erginel S, Alatas F, Yilmaz S, Metintas S. Image-Assısted Pleural Needle Biopsy or Medical Thoracoscopy: Which Method for Which Patient? A Randomızed Controlled Trial. Chest 2024:S0012-3692(24)00427-6. [PMID: 38554817 DOI: 10.1016/j.chest.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Image-guided or assisted needle biopsies and the increasing use of medical thoracoscopy (MT) have increased the diagnostic accuracy of pleural diseases significantly. However, no consensus exists regarding which patients with pleural effusion should undergo MT and which patients should undergo image-guided or assisted needle biopsy as the first procedure to ensure greater diagnostic accuracy. RESEARCH QUESTION Which biopsy method is more appropriate for which patient to provide the highest diagnostic accuracy in the diagnosis of pleural effusion? STUDY DESIGN AND METHODS This prospective, randomized, parallel study included 228 patients with undiagnosed exudative pleural effusion. Patients were divided into two groups based on CT scan findings. Group 1 included patients with pleural effusion only. Group 2 included patients with pleural thickening or lesion in addition to pleural effusion. Patients in each group were assigned randomly to an image-assisted Abrams needle pleural biopsy (IA-ANPB) or MT arm. The diagnostic sensitivity, reliability, and safety were determined for both groups. RESULTS The false-negative rate was 30.3% for the IA-ANPB arm and 3.1% for the MT arm in group 1. The same rates were 11.9% for IA-ANPB and 4.7% for MT in group 2. In group 1, the sensitivity for the IA-ANPB arm was 69.7%, and the negative likelihood ratio was 0.30. The same rates for the MT arm were 96.9% and 0.03 (P = .009). In group 2, these values were 88.1% and 0.12 for the IA-ANPB arm and 95.4% and 0.05 for the MT arm (P = .207). The rate of complications between the two biopsy methods was not different (8.5% and 15.8%, respectively; P = .107). INTERPRETATION MT showed a high diagnostic success in all patients with pleural fluid. However, IA-ANPB showed similar diagnostic success as MT in patients with pleural effusion and associated pleural thickening or lesions. Therefore, in the latter case, IA-ANPB could be preferable to MT. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT05428891; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Muzaffer Metintas
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey; Lung and Pleural Cancers Clinical and Research Center, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Guntulu Ak
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey; Lung and Pleural Cancers Clinical and Research Center, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Huseyin Yildirim
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Emine Dundar
- Department of Pathology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Nevin Aydin
- Department of Radiology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Sinan Erginel
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Fusun Alatas
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Senay Yilmaz
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Selma Metintas
- Department of Public Health, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
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Gonnelli F, Hassan W, Bonifazi M, Pinelli V, Bedawi EO, Porcel JM, Rahman NM, Mei F. Malignant pleural effusion: current understanding and therapeutic approach. Respir Res 2024; 25:47. [PMID: 38243259 PMCID: PMC10797757 DOI: 10.1186/s12931-024-02684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality and elevated costs to healthcare systems. Over the last decades the understanding of pathophysiology mechanisms, diagnostic techniques and optimal treatment intervention in MPE have been greatly advanced by recent high-quality research, leading to an ever less invasive diagnostic approach and more personalized management. 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. In the next future, because of a better understanding of underlying tumor biology together with more sensitive molecular diagnostic techniques, it is likely that combined diagnostic and therapeutic procedures allowing near total outpatient management of MPE will become popular. This article provides a review of the current advances, new discoveries and future directions in the pathophysiology, diagnosis and management of MPE.
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Affiliation(s)
- Francesca Gonnelli
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy
| | - Wafa Hassan
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, University of Sheffield, Sheffield, UK
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy
| | | | - Eihab O Bedawi
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, University of Sheffield, Sheffield, UK
| | - José M Porcel
- Research Group of Cancer Biomarkers, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Pleural Medicine and Clinical Ultrasound Unit, Department of Internal Medicine, Arnau de Vilanova, University Hospital, Lleida, Spain
| | - Najib M Rahman
- Oxford Pleural Unit, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Unit, Oxford, UK
- Chinese Academy of Medicine Oxford Institute, Oxford, UK
| | - Federico Mei
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona Via Conca 71, Ancona, 60126, Italy.
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4
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Guinde J, Dutau H, Astoul P. Management of Malignant Pleural Effusion: Where Are We Now? Semin Respir Crit Care Med 2022; 43:559-569. [PMID: 35613947 DOI: 10.1055/s-0042-1748185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pleural malignancies are among the most common causes of pleural disease and form the basis of our daily pleural practice. There has been significant research and increase in both diagnostic and therapeutic management of malignant pleural diseases in the last decade. Good-quality data have led to a paradigm shift in the management options of pleural malignancies, and indwelling pleural catheter is now recommended and widely used as first-line intervention. Several trials compared different treatment modalities for pleural malignancies and continue to emphasize the need to reduce hospital length of stay and unnecessary pleural intervention, and the importance of patient choice in clinical decision making. This practical review aims to summarize the current knowledge for the management of pleural malignancies, and the understanding of the steps that we still have to climb to optimize management and reduce morbidity.
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Affiliation(s)
- Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France.,Aix-Marseille University, Marseille, France
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5
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Addala DN, Kanellakis NI, Bedawi EO, Dong T, Rahman NM. Malignant pleural effusion: Updates in diagnosis, management and current challenges. Front Oncol 2022; 12:1053574. [PMID: 36465336 PMCID: PMC9712949 DOI: 10.3389/fonc.2022.1053574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022] Open
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.
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Affiliation(s)
- Dinesh Narayan Addala
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Oxford Pleural Unit, Oxford University Hospitals, Oxford, United Kingdom
| | - Nikolaos I Kanellakis
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Oxford Biomedical Research Centre, National Institute for Health Research, Oxford, United Kingdom.,Nuffield Department of Medicine, Medical Sciences Division, Chinese Academy of Medical Science Oxford Institute, University of Oxford, Oxford, United Kingdom
| | - Eihab O Bedawi
- Oxford Pleural Unit, Oxford University Hospitals, Oxford, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Tao Dong
- Nuffield Department of Medicine, Medical Sciences Division, Chinese Academy of Medical Science Oxford Institute, University of Oxford, Oxford, United Kingdom.,Medical Research Council (MRC) Human Immunology Unit, Radcliffe Department of Medicine, Medical Research Council (MRC) Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Oxford Pleural Unit, Oxford University Hospitals, Oxford, United Kingdom.,Oxford Biomedical Research Centre, National Institute for Health Research, Oxford, United Kingdom.,Nuffield Department of Medicine, Medical Sciences Division, Chinese Academy of Medical Science Oxford Institute, University of Oxford, Oxford, United Kingdom
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Bedawi EO, Guinde J, Rahman NM, Astoul P. Advances in pleural infection and malignancy. Eur Respir Rev 2021; 30:200002. [PMID: 33650525 PMCID: PMC9488125 DOI: 10.1183/16000617.0002-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/12/2020] [Indexed: 02/03/2023] Open
Abstract
Pleural infection and malignancy are among the most common causes of pleural disease and form the mainstay of pleural practice. There has been significant research and increase in scientific understanding in these areas in the past decade. With regard to pleural infection, the rising incidence remains worrying. An increased awareness allowing earlier diagnosis, earlier escalation of therapy and the use of validated risk stratification measures may improve outcomes. In pleural malignancy, research has enabled clinicians to streamline patient pathways with focus on reducing time to diagnosis, definitive management of malignant pleural effusion and achieving these with the minimum number of pleural interventions. Trials comparing treatment modalities of malignant pleural effusion continue to highlight the importance of patient choice in clinical decision-making. This article aims to summarise some of the most recent literature informing current practice in these two areas.
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Affiliation(s)
- Eihab O Bedawi
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, UK
| | - Julien Guinde
- Dept of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Najiib M Rahman
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Philippe Astoul
- Dept of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North University Hospital, Marseille, France
- Aix-Marseille University, Marseille, France
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7
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Lin Z, Wu D, Wang J, Wang C, Huang M. Diagnostic value of ultrasound-guided needle biopsy in undiagnosed pleural effusions: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21076. [PMID: 32629740 PMCID: PMC7337470 DOI: 10.1097/md.0000000000021076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Undiagnosed pleural effusions (UPEs) are a common problem of respiratory medicine, leading to an increased diagnostic burden globally. However, the most efficient and cost-effective approaches to UPEs remain controversial. This study aimed to assess the diagnostic value of ultrasound-guided needle biopsy (UGNB) in UPEs. METHODS We conducted a search of PubMed, Embase, the Cochrane Library and reference lists of retrieved studies with no publication data limitation. Articles that investigated the diagnostic accuracy of UGNB in UPEs were included. The quality of eligible studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. The diagnostic value of UGNB was evaluated by calculating the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds rate, and the area under the curve for the summary receiver operating characteristic curve using a random effects model. RESULTS Seven studies comprising 165 patients with UPEs met the inclusion criteria. UGNB had a pooled sensitivity of 83% (95% confidence intervals [CI], 75% - 89%), a specificity of 100% (95% CI, 90% - 100%), a positive likelihood ratio of 8.89 (95% CI, 3.29 - 24.02), a negative likelihood ratio of 0.23 (95% CI, 0.16 - 0.33), a diagnostic odds rate of 51.47 (95% CI, 14.70 - 180.16), and an area under the curve of 0.94. Six pneumothorax cases (3.6%), 5 local wound infections (3.0%), and 1 empyema case (less than 1%) were observed. There was no significant heterogeneity or publication bias in this study. CONCLUSIONS Based on current evidence, UGNB is a safe and convenient procedure with a high accuracy for diagnosing UPEs. However, physicians should still be cautious in interpreting negative UGNB results.
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Affiliation(s)
- Zhidi Lin
- Department of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health
- Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Donghong Wu
- Department of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health
- Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jinlin Wang
- Department of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health
| | - Chuqiao Wang
- Department of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health
- Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mingkai Huang
- Department of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health
- Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong, China
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8
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Prospective Study of the Utility of Computed Tomography Triage of Pleural Biopsy Strategies in Patients With Pleural Diseases. J Bronchology Interv Pulmonol 2019; 26:210-218. [PMID: 31211722 DOI: 10.1097/lbr.0000000000000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study aimed to prospectively evaluate the efficacy and reliability of a diagnostic workup, triaging pleural biopsy method according to baseline computerized tomography (CT) findings in the diagnosis of pleural diseases. METHODS Patients with pleural pathology were divided into 3 arms according to findings on CT scan images. Arm A: patients with pleural thickening/lesion in addition to pleural effusion. These patients underwent CT scan-guided Abrams' needle pleural biopsy. Arm B: patients with pleural effusion alone or suspected benign asbestos pleurisy. This group underwent medical thoracoscopy (MT). Arm C: patients with only pleural thickening. This group underwent ultrasonography-guided cutting needle pleural biopsy. MT was planned in patients who did not have a specific diagnosis in the CT scan-guided Abrams' needle pleural biopsy group. When patients with a histopathologic diagnosis of fibrinous pleuritis after MT were assessed in terms of the risk factors for malignant pleural diseases, we offered a further invasive procedure. RESULTS A total of 164 patients were enrolled in the study. Diagnostic sensitivity after the initial procedure was 90.2% in Arm A, 93.3% in Arm B, 95.2% in Arm C, and 92.4% in the entire workup. The negative predictive value of the entire workup was 90.4% for malignant pleural mesothelioma, 97.1% for metastatic malignant pleural diseases, and 100% for tuberculous pleurisy. Five cases who had a diagnosis of fibrinous pleuritis after MT were detected to have risk factors, 4 of which (80%) indicated malignant disease. Complication rates were low and acceptable. CONCLUSION Use of CT scans to triage an appropriate pleural biopsy method is associated with high diagnostic success. We recommend that the proposed diagnostic workup in this study may be used as a diagnostic algorithm for pleural diseases that require a histopathologic analysis. Determination of risk factors predicting malignant disease in patients where fibrinous pleuritis is reported after MT would be useful for clinical practice.
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Zhang Y, Tang J, Zhou X, Zhou D, Wang J, Tang Q. Ultrasound-guided pleural cutting needle biopsy: accuracy and factors influencing diagnostic yield. J Thorac Dis 2018; 10:3244-3252. [PMID: 30069320 DOI: 10.21037/jtd.2018.05.94] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background The aim of this study was to retrospectively investigate the diagnostic accuracy of ultrasound-guided pleural cutting needle biopsy (US-guided PCNB) and the potential factors influencing diagnostic yield. Methods From July 2014 to June 2016, a total of 147 percutaneous US-guided PCNBs in 144 patients were retrospectively reviewed. The final diagnosis was confirmed by histopathological analysis and follow-up. We calculated diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and divided all cases into group of correct diagnoses (true-positive and true-negative cases) and group of incorrect diagnoses (false-positive, false-negative, and inconclusive cases). Univariate and multivariate logistic regression analyses were performed to analyze the differences of influencing factors (patient, pleura, and biopsy-associated factors) in the between the two groups. Results Seven patients were excluded because of loss to follow-up. A total of 140 cases were ultimately included (105 males and 35 females). There were 105 cases in the correct diagnosis group, and 35 cases in the incorrect diagnosis group. The overall accuracy of US-PCNB was 75.0% and the sensitivity, specificity, PPV, NPV in malignant diagnosis were 58.1%, 99.0%, 96.2%, and 84.2%, respectively. On univariate analysis, variables affecting diagnostic accuracy of US-PCNB were the pleural thickness (<3 mm in thickness 61.0%, ≥3 mm in thickness 85.2%; P=0.001), morphology (non-nodular pleura 71.4%, nodular pleura 95.2%; P=0.026), and needle size (18 G 69.1%, 16 G 87.0%; P=0.022). Finally multivariate logistic regression demonstrated that pleural thickness [odds ratio (OR): 0.278, P=0.003] and needle size (OR: 0.291, P=0.018) independently predicted diagnostic accuracy. Conclusions Pleural thickness and the size of the biopsy needle were significantly correlated with the diagnostic yield.
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Affiliation(s)
- Yuxin Zhang
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jiaxin Tang
- Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xinghua Zhou
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Dazhi Zhou
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jinlin Wang
- Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Qing Tang
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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10
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Comparative study between the use of image guided pleural biopsy using abram’s needle and medical thoracoscope in diagnosis of exudative pleural effusion. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Corcoran JP, Tazi-Mezalek R, Maldonado F, Yarmus LB, Annema JT, Koegelenberg CFN, St Noble V, Rahman NM. State of the art thoracic ultrasound: intervention and therapeutics. Thorax 2017; 72:840-849. [PMID: 28411248 DOI: 10.1136/thoraxjnl-2016-209340] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 03/14/2017] [Accepted: 03/23/2017] [Indexed: 12/25/2022]
Abstract
The use of thoracic ultrasound outside the radiology department and in everyday clinical practice is becoming increasingly common, having been incorporated into standards of care for many specialties. For the majority of practitioners, their experience of, and exposure to, thoracic ultrasound will be in its use as an adjunct to pleural and thoracic interventions, owing to the widely recognised benefits for patient safety and risk reduction. However, as clinicians become increasingly familiar with the capabilities of thoracic ultrasound, new directions for its use are being sought which might enhance practice and patient care. This article reviews the ways in which the advent of thoracic ultrasound is changing the approach to the investigation and treatment of respiratory disease from an interventional perspective. This will include the impact of thoracic ultrasound on areas including patient safety, diagnostic and therapeutic procedures, and outcome prediction; and will also consider potential future research and clinical directions.
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Affiliation(s)
- John P Corcoran
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
| | - Rachid Tazi-Mezalek
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lonny B Yarmus
- Division of Pulmonary and Critical Care Medicine, John Hopkins University, Baltimore, Maryland, USA
| | - Jouke T Annema
- Department of Pulmonology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa.,Tygerberg Academic Hospital, Cape Town, South Africa
| | - Victoria St Noble
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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12
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Bhatnagar R, Corcoran JP, Maldonado F, Feller-Kopman D, Janssen J, Astoul P, Rahman NM. Advanced medical interventions in pleural disease. Eur Respir Rev 2017; 25:199-213. [PMID: 27246597 DOI: 10.1183/16000617.0020-2016] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/17/2016] [Indexed: 12/18/2022] Open
Abstract
The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy. We also aim to inform the reader regarding the latest updates to more established procedures such as chemical pleurodesis, thoracentesis and the management of chest drains, drawing on contemporary data from recent randomised trials. Finally, we shall look to explore the challenges faced by those practicing pleural medicine, especially relating to training, as well as possible future directions for the use and expansion of advanced medical interventions in pleural disease.
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Affiliation(s)
- Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK These authors contributed equally
| | - John P Corcoran
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK These authors contributed equally
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, John Hopkins University, Baltimore, MD, USA
| | - Julius Janssen
- Department of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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13
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Abstract
INTRODUCTION Pleural disease encompasses a large range of conditions, is a common presentation to the acute medical take and often requires comprehensive investigation and treatment. Ultrasound is well recognised as a useful investigative tool in pleural disease especially in the field of pleural effusion, pleural thickening and interventional procedures. Thoracic ultrasound (TUS) has gained widespread use by physicians as evidence has shown a reduced rate of complications when performing pleural procedures with ultrasound guidance. Areas covered: This article will review studies assessing the role of TUS in the management of pleural disease and examine ongoing research into how TUS could advance our knowledge and understanding over the next decade. Expert commentary: Physician lead thoracic ultrasound has become commonplace over the last decade, and now represents a minimum standard of safety in conducting the majority of 'bedside' pleural procedures. The current evidence points to important diagnostic and procedural roles of the use of bedside thoracic ultrasound. In the future, research developments are likely to lead to the use of thoracic ultrasound in prognostication, targeted treatment and understanding pathogenesis in pleural disease.
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Affiliation(s)
- Rachel M Mercer
- a University of Oxford Respiratory Trials Unit , Churchill Hospital , Oxford , UK.,b Oxford Centre for Respiratory Medicine , Oxford University Hospitals NHS Trust , Oxford , UK
| | - Ioannis Psallidas
- a University of Oxford Respiratory Trials Unit , Churchill Hospital , Oxford , UK.,b Oxford Centre for Respiratory Medicine , Oxford University Hospitals NHS Trust , Oxford , UK
| | - Najib M Rahman
- a University of Oxford Respiratory Trials Unit , Churchill Hospital , Oxford , UK.,b Oxford Centre for Respiratory Medicine , Oxford University Hospitals NHS Trust , Oxford , UK.,c NIHR Oxford Biomedical Research Centre , University of Oxford , Oxford , UK
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14
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Metintas M, Yildirim H, Kaya T, Ak G, Dundar E, Ozkan R, Metintas S. CT Scan-Guided Abrams' Needle Pleural Biopsy versus Ultrasound-Assisted Cutting Needle Pleural Biopsy for Diagnosis in Patients with Pleural Effusion: A Randomized, Controlled Trial. Respiration 2016; 91:156-63. [DOI: 10.1159/000443483] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/15/2015] [Indexed: 11/19/2022] Open
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Dixon G, de Fonseka D, Maskell N. Pleural controversies: image guided biopsy vs. thoracoscopy for undiagnosed pleural effusions? J Thorac Dis 2015; 7:1041-51. [PMID: 26150917 DOI: 10.3978/j.issn.2072-1439.2015.01.36] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 01/15/2015] [Indexed: 12/14/2022]
Abstract
Undiagnosed pleural effusions present an increasing diagnostic burden upon healthcare providers internationally. The investigation of pleural effusions often requires the acquisition of tissue for histological analysis and diagnosis. Historically there were two options for tissue biopsy: a 'gold standard' surgical biopsy or a "blind" closed pleural biopsy. Over the last decade however, image-guided Tru-cut biopsies and local anaesthetic thoracoscopic (local anaesthetic thoracoscopy) biopsies have become more widespread. Image-guided techniques acquire samples under ultrasound (US) or computed tomography (CT) guidance whereas LAT involves the direct visualisation and biopsy of the pleura with pleuroscopy. Both techniques have been shown to be superior to 'blind' closed pleural biopsy for the diagnosis of pleural or metastatic malignancy. However, closed biopsy remains a viable method of investigation in areas of high incidence of tuberculosis (TB). Beyond this, each investigative technique has its own advantages and disadvantages. Image-guided biopsy is less invasive, usually carried out as an outpatient procedure, and enables tissue biopsy in frail patients and those with pleural thickening but no pleural fluid. Local anaesthetic thoracoscopy (LAT) provides diagnostic and therapeutic capabilities in one procedure. Large volume thoracentesis, multiple pleural biopsies and talc poudrage can be carried out in a single procedure. The overall diagnostic yield is similar for both techniques, although there are no large-scale direct comparisons. Both techniques share low complication rates.
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Affiliation(s)
- Giles Dixon
- 1 North Bristol NHS Trust, Bristol, UK ; 2 Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Duneesha de Fonseka
- 1 North Bristol NHS Trust, Bristol, UK ; 2 Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Nick Maskell
- 1 North Bristol NHS Trust, Bristol, UK ; 2 Academic Respiratory Unit, University of Bristol, Bristol, UK
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16
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Son HS, Lee SH, Darlong LM, Jung JS, Sun K, Kim KT, Kim HJ, Lee K, Lee SH, Lee JT. Is There a Role for a Needle Thoracoscopic Pleural Biopsy under Local Anesthesia for Pleural Effusions? THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:124-8. [PMID: 24782961 PMCID: PMC4000868 DOI: 10.5090/kjtcs.2014.47.2.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/14/2013] [Accepted: 10/15/2013] [Indexed: 11/21/2022]
Abstract
Background A closed pleural biopsy is commonly performed for diagnosing patients exhibiting pleural effusion if prior thoracentesis is not diagnostic. However, the diagnostic yield of such biopsies is unsatisfactory. Instead, a thoracoscopic pleural biopsy is more useful and less painful. Methods We compared the diagnostic yield of needle thoracoscopic pleural biopsy performed under local anesthesia with that of closed pleural biopsy. Sixty-seven patients with pleural effusion were randomized into groups A and B. Group A patients were subjected to closed pleural biopsies, and group B patients were subjected to pleural biopsies performed using needle thoracoscopy under local anesthesia. Results The diagnostic yields and complication rates of the two groups were compared. The diagnostic yield was 55.6% in group A and 93.5% in group B (p<0.05). Procedure-related complications developed in seven group A patients but not in any group B patients. Of the seven complications, five were pneumothorax and two were vasovagal syncope. Conclusion Needle thoracoscopic pleural biopsy under local anesthesia is a simple and safe procedure that has a high diagnostic yield. This procedure is recommended as a useful diagnostic modality if prior thoracentesis is non-diagnostic.
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Affiliation(s)
- Ho Sung Son
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Korea
| | - Sung Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Korea
| | | | - Jae Seong Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Korea
| | - Kyung Sun
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Korea
| | - Kwang Taik Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Korea
| | - Hee Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Korea
| | - Kanghoon Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Korea
| | - Seung Hun Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Korea
| | - Jong Tae Lee
- Korea Artificial Organ Center, Korea University, Korea
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van Zandwijk N, Clarke C, Henderson D, Musk AW, Fong K, Nowak A, Loneragan R, McCaughan B, Boyer M, Feigen M, Currow D, Schofield P, Nick Pavlakis BI, McLean J, Marshall H, Leong S, Keena V, Penman A. Guidelines for the diagnosis and treatment of malignant pleural mesothelioma. J Thorac Dis 2013; 5:E254-307. [PMID: 24416529 PMCID: PMC3886874 DOI: 10.3978/j.issn.2072-1439.2013.11.28] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/25/2013] [Indexed: 12/24/2022]
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Berk S, Dogan OT, Kilickap S, Epozturk K, Akkurt I, Seyfikli Z. Clinical characteristics, treatment and survival outcomes in malignant mesothelioma: eighteen years' experience in Turkey. Asian Pac J Cancer Prev 2013; 13:5735-9. [PMID: 23317248 DOI: 10.7314/apjcp.2012.13.11.5735] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malignant mesothelioma (MM) is an insidious tumor with poor prognosis, arising from mesothelial surfaces such as pleura, peritoneum and pericardium. We here aimed to evaluate the demographic, clinical, and radiological features of patients with MM followed in our center as well as their survival. METHODS The study included 228 patients (131 male, 97 female) who were followed up in our institution between 1993 and 2010 with the diagnosis of MM. RESULTS The mean age was 59.1 years in men and 58.7 years in women and the sex ratio was 1.4:1 in favor of males. Environmental asbestos exposure was present in 86% of the patients for a mean duration of 40±20 years (range: 3-70). Pleural effusion and thoracic/abdominal pain were the most common presenting signs and symptoms (70.2% and 57.8%, respectively). One hundred-thirteen (66%) patients were treated with platinum-based combination chemotherapy (PBCT) plus supportive care (SC) and 67 (34%) patients received SC alone. The median follow-up time was 10.0 months. The median overall survival was significantly improved with PBCT plus SC compared to SC alone (11.4 vs. 5.1 months; p=0.005). The 6, 12, 18, and 24-month survival rates were significantly improved with PBCT plus SC compared to SC alone (72%, 43%, 19%, and 2% vs. 49%, 31%, 11%, and 1%). CONCLUSION The survival of patients with MM improved in patients treated with PBCT. The survival advantage continued 12- and 24-month after the initial time of combination chemotherapy.
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Affiliation(s)
- Serdar Berk
- Department of Chest Diseases, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
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The Safety of Medical Thoracoscopy in a Group at High Risk for Complications. J Bronchology Interv Pulmonol 2013; 20:224-31. [DOI: 10.1097/lbr.0b013e31829ebdbb] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Second Italian Consensus Conference on Malignant Pleural Mesothelioma: State of the art and recommendations. Cancer Treat Rev 2013; 39:328-39. [DOI: 10.1016/j.ctrv.2012.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 11/08/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
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Pleuroscopy: a window of "opportunity". J Bronchology Interv Pulmonol 2012; 17:191-2. [PMID: 23168881 DOI: 10.1097/lbr.0b013e3181e74187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stigt JA, Boers JE, Groen HJM. Analysis of "dry" mesothelioma with ultrasound guided biopsies. Lung Cancer 2012; 78:229-33. [PMID: 23021044 DOI: 10.1016/j.lungcan.2012.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/13/2012] [Accepted: 09/03/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Image-guided sampling of the thickened pleura is a sensitive approach in patients with malignant pleural mesothelioma with pleural effusion. Malignant pleural mesothelioma presenting without effusion however is more of a diagnostic challenge. In this study we report the diagnostic yield and complications of ultrasound-guided cutting needle biopsies in this particular category of patients. METHODS A retrospective database analysis from September 2007 until January 2012 was performed in 56 patients with malignant pleural mesothelioma. Clinical characteristics and results of diagnostic evaluations were analysed. RESULTS Of the 56 patients with malignant pleural mesothelioma, 20 patients presented without pleural effusion of with locular effusion. Ultrasound-guided cutting needle biopsy was performed in 14/20 patients with a diagnostic accuracy of 80%. Only 1 patient had mild haemoptysis immediately following biopsies. CONCLUSION Diagnosing patients with pleural thickenings suspect for malignant mesothelioma without pleural effusion or with loculated pleural effusion is effective and safe with ultrasound-guided cutting needle biopsies.
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Affiliation(s)
- Jos A Stigt
- Department of Pulmonology, Isala Klinieken, Zwolle, The Netherlands.
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Abstract
The incidence of mesothelioma continues to increase in the Western world and is likely to do so until 2011-2015. It commonly presents with breathlessness secondary to a pleural effusion, and whilst guidelines still advise thoracocentesis as the first line investigation, the sensitivity of this is low and a tissue diagnosis is usually required. Abrams needle biopsy also has a low diagnostic yield and high complication rate and is not recommended in guidelines on the investigation of mesothelioma. Computed tomography-guided biopsy or thoracoscopy both have a comparable sensitivity and low complication rates. Local anaesthetic thoracoscopy is increasingly used by respiratory physicians and has a comparable diagnostic sensitivity to Video-Assisted Thoracoscopic Surgery (VATS) without the need for a general anaesthetic. The requirement for prophylactic radiotherapy after pleural procedures in cases of mesothelioma is contentious, as the results from early trials suggesting it reduces tract seeding have been disputed by more recent trials.
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Diagnosis and treatment of malignant pleural effusion: a systematic literature review and new approaches. Am J Clin Oncol 2010; 33:420-3. [PMID: 19858695 DOI: 10.1097/coc.0b013e3181aacbbf] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malignant pleural effusion is a frequent complication in many types of tumors, and its presence indicates short expected survival. This review updates the current knowledge about diagnosis and management of malignant pleural effusion. In recent years, progress has been made in diagnosis through the use of new pathologic and radiologic approaches, such as the introduction of positron emission tomography-computed tomography, immunohistochemical marker combinations, and genetic studies to identify malignant cells. Treatment is always palliative. New promising drugs have been tested, but, awaiting randomized studies, talc pleurodesis is still the treatment of choice, although doubts remain about its safety. A long-term indwelling pleural catheter could be a valid alternative to talc pleurodesis in selected patients with trapped lung syndrome (a lung that fails to reexpand after drainage of pleural effusion) and short life expectancy. However, the correct treatment depends on several factors such as performance status, expected survival, presence of lung reexpansion following pleural drainage and comorbidities.
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Abstract
INTRODUCTION To determine the cause of an exudative pleural effusion, clinicians may choose one of the three types of pleural biopsies--blind, image-guided, or surgical biopsies--depending on the extent of pleural involvement and the available expertise and technology. The purpose of this study was to examine the trends in the type of pleural biopsies performed between 1996 and 2006 and to assess the diagnostic sensitivity of the 3 aforementioned types of pleural biopsy. METHODS This was a retrospective study of all patients who underwent a pleural biopsy at a large teaching hospital between January 1, 1996, and December 31, 2006. Patients were identified by reviewing databases for surgical pathology and hospital discharge. The final diagnosis was determined by conducting a detailed chart review. We examined the trend in pleural biopsies from 1996 and 2006. We also compared the disease-specific sensitivity of blind, image-guided and surgical biopsies. RESULTS Of the 174 pleural biopsy specimens identified, 103 (59.1%) were blind, 38 (21.8%) were image guided (ultrasound and computed tomography), and 33 (18.9%) were surgical (video-assisted thoracoscopic surgery and open surgical). The proportion of blind pleural biopsies performed declined from 77.7% in 1996 to 26.6% in 2006 (P < 0.0001). During the same period, the proportion of image-guided biopsy rose from 7.4% to 53.3% (P < 0.001). The sensitivity of blind, image-guided and surgical biopsy was 42%, 78.7%, and 92.8%, respectively. CONCLUSIONS The number of blind pleural biopsies performed by pulmonary fellows declined substantially between 1996 and 2006, with an increasing trend toward image-guided biopsy.
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Metintas M, Ak G, Dundar E, Yildirim H, Ozkan R, Kurt E, Erginel S, Alatas F, Metintas S. Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial. Chest 2010; 137:1362-8. [PMID: 20154079 DOI: 10.1378/chest.09-0884] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In cases of pleural effusion, tissue samples can be obtained through Abrams needle pleural biopsy (ANPB), thoracoscopy, or cutting-needle pleural biopsy under the guidance of CT scan (CT-CNPB) for histopathologic analysis. This study aimed to compare the diagnostic efficiency and reliability of ANPB under CT scan guidance (CT-ANPB) with that of medical thoracoscopy in patients with pleural effusion. METHODS Between January 2006 and January 2008, 124 patients with exudative pleural effusion that could not be diagnosed by cytologic analysis were included in the study. All patients were randomized after the CT scan was performed. Patients either underwent CT-ANPB or thoracoscopy. The two groups were compared in terms of diagnostic sensitivity and complications associated with the methods used. RESULTS Of the 124 patients, malignant mesothelioma was diagnosed in 33, metastatic pleural disease in 47, benign pleural disease in 42, and two were of indeterminate origin. In the CT-ANPB group, the diagnostic sensitivity was 87.5%, as compared with 94.1% in the thoracoscopy group; the difference was not statistically significant (P = .252). No difference was identified between the sensitivities of the two methods based on the cause, the CT scan findings, and the degree of pleural thickening. Complication rates were low and acceptable. CONCLUSION We recommend the use of CT-ANPB as the primary method of diagnosis in patients with pleural thickening or lesions observed by CT scan. In patients with only pleural fluid appearance on CT scan and in those who may have benign pleural pathologies other than TB, the primary method of diagnosis should be medical thoracoscopy. TRIAL REGISTRATION clinicaltrials.gov; Identifier: NCT00720954.
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Affiliation(s)
- Muzaffer Metintas
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey 26040.
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Pinilla I, Gómez León N. [The usefulness of PET/CT in lung cancer]. RADIOLOGIA 2009; 51:248-60. [PMID: 19406442 DOI: 10.1016/j.rx.2009.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 01/09/2009] [Indexed: 12/20/2022]
Abstract
Lung cancer is the leading cause of cancer-related death. Accurate staging is essential for the optimal management and treatment of these patients. Positron emission tomography (PET) and, more recently, PET/CT have been introduced into the diagnostic algorithms for oncologic patients because they provide valuable functional information. The hybrid PET/CT technique acquires both anatomic (CT) and metabolic (PET) images in a single session, combining the benefits of each modality and minimizing their limitations. This article reviews the role of PET/CT in lung cancer staging, with emphasis on non-small cell carcinoma, evaluating the advantages and limitations of the technique. Other applications of the technique, such as planning radiotherapy, are also discussed.
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Affiliation(s)
- I Pinilla
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, España.
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