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Laberiano-Fernandez C, Gan Q, Wang SM, Tamegnon A, Wistuba I, Yoon E, Roy-Chowdhuri S, Parra ER. Exploratory pilot study to characterize the immune landscapes of malignant pleural effusions and their corresponding primary tumors from patients with breast carcinoma and lung adenocarcinoma. J Am Soc Cytopathol 2024; 13:161-173. [PMID: 38519275 DOI: 10.1016/j.jasc.2024.02.005] [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: 12/30/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Malignant pleural effusion (MPE) is a frequent complication of advanced malignancies. In this pilot study, we characterized the immune landscapes of MPEs, compared them to their primary tumor (PT) samples from breast carcinoma (BC) and lung adenocarcinoma (LADC), and tested the utility of multiplexed image technology in cytological samples. MATERIALS AND METHODS We evaluated the immune contexture of 6 BC and 5 LADC MPEs and their PTs using 3 multiplex immunofluorescence panels. We explored the associations between sample characteristics and pleural effusion-free survival. RESULTS No MPE samples had positive programmed death-ligand 1 expression in malignant cells, although 3 of 11 PTs has positive programmed death-ligand 1 expression (more than 1% expression in malignant cells). Overall, in LADC samples, cluster of differentiation 3 (CD3)+ T cells and CD3+CD8+ cytotoxic T cells predominated (median percentages for MPEs versus PTs: 45.6% versus 40.7% and 4.7% versus 6.6%, respectively) compared with BC. CD68+ macrophages predominated in the BC samples (medians for MPEs 61.2% versus PTs for 57.1%) but not in the LADC samples. Generally in PTs, CD3+CD8+ forkhead box P3+ T cells and the median distances from the malignant cells to CD3+CD8+Ki67+ and CD3+ programmed cell death protein 1 + T cells correlated to earlier MPE after PT diagnosis. CONCLUSIONS The immune cell phenotypes in the MPEs and PTs were similar within each cancer type but different between BC versus LADC. An MPE analysis can potentially be used as a substitute for a PT analysis, but an expanded study of this topic is essential.
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Affiliation(s)
- Caddie Laberiano-Fernandez
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qiong Gan
- Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sophia Mei Wang
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Auriole Tamegnon
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ignacio Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Esther Yoon
- Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sinchita Roy-Chowdhuri
- Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edwin Roger Parra
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Messa GE, Fontenot CJ, Deville PE, Hunt JP, Marr AB, Schoen JE, Stuke LE, Greiffenstein PP, Smith AA. Chest Tube Size Selection: Evaluating Provider Practices, Treatment Efficacy, and Complications in Management of Thoracic Trauma. Am Surg 2024:31348241241735. [PMID: 38557288 DOI: 10.1177/00031348241241735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND The standard for managing traumatic pneumothorax (PTX), hemothorax (HTX), and hemopneumothorax (HPTX) has historically been large-bore (LB) chest tubes (>20-Fr). Previous studies have shown equal efficacy of small-bore (SB) chest tubes (≤19-Fr) in draining PTX and HTX/HPTX. This study aimed to evaluate provider practice patterns, treatment efficacy, and complications related to the selection of chest tube sizes for patients with thoracic trauma. METHODS A retrospective chart review was performed on adult patients who underwent tube thoracostomy for traumatic PTX, HTX, or HPTX at a Level 1 Trauma Center from January 2016 to December 2021. Comparison was made between SB and LB thoracostomy tubes. The primary outcome was indication for chest tube placement based on injury pattern. Secondary outcomes included retained hemothorax, insertion-related complications, and duration of chest tube placement. Univariate and multivariate analyses were performed. RESULTS Three hundred and forty-one patients were included and 297 (87.1%) received LB tubes. No significant differences were found between the groups concerning tube failure and insertion-related complications. LB tubes were more frequently placed in patients with penetrating MOI, higher average ISS, and higher average thoracic AIS. Patients who received LB chest tubes experienced a higher incidence of retained HTX. DISCUSSION In patients with thoracic trauma, both SB and LB chest tubes may be used for treatment. SB tubes are typically placed in nonemergent situations, and there is apparent provider bias for LB tubes. A future randomized clinical trial is needed to provide additional data on the usage of SB tubes in emergent situations.
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Affiliation(s)
- Genevieve E Messa
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
| | - Cameron J Fontenot
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
| | - Paige E Deville
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
| | - John P Hunt
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Alan B Marr
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Jonathan E Schoen
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Lance E Stuke
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Patrick P Greiffenstein
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Alison A Smith
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
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Efteev LA, Esakov YS, Blinova EV, Bazylyuk AV, Blinov KD. [Treatment of malignant effusion]. Khirurgiia (Mosk) 2024:141-147. [PMID: 39008708 DOI: 10.17116/hirurgia2024071141] [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] [Indexed: 07/17/2024]
Abstract
Malignant effusion complicates more than 15% of all cancers in delayed stages of progression. The most common causes of metastatic pleuritis are lung cancer, breast cancer, ovarian cancer, lymphoproliferative diseases or dissemination of gastrointestinal tumors. Malignant effusion is associated with negative prognosis for overall survival regardless of etiology of tumor, significantly complicates the course of the underlying disease, impairs life quality and complicates treatment. Despite various methods for pleural cavity obliteration in recurrent metastatic pleuritis, there is still no a uniform approach to choosing the optimal treatment strategy. We analyzed the main methods of conservative and surgical treatment of recurrent metastatic pleuritic regarding efficacy, risk of recurrence and reproducibility.
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Affiliation(s)
- L A Efteev
- Clinical Oncological Hospital N. 1, Moscow, Russia
| | - Yu S Esakov
- Clinical Oncological Hospital N. 1, Moscow, Russia
| | - E V Blinova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Bazylyuk
- Clinical Oncological Hospital N. 1, Moscow, Russia
| | - K D Blinov
- Sechenov First Moscow State Medical University, Moscow, Russia
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Cohen SE, Betancourt J, Soo Hoo GW. Pleural Uptake Patterns in F18Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) Scans Improve the Identification of Malignant Pleural Effusions. J Clin Med 2023; 12:6977. [PMID: 38002592 PMCID: PMC10672363 DOI: 10.3390/jcm12226977] [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: 09/09/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The confirmation of malignant pleural effusions (MPE) requires an invasive procedure. Diagnosis can be difficult and may require repeated thoracentesis or biopsies. F18Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) can characterize the extent of malignant involvement in areas of increased uptake. Patterns of uptake in the pleura may be sufficient to obviate the need for further invasive procedures. METHODS This is a retrospective review of patients with confirmed malignancy and suspected MPE. Patients who underwent diagnostic thoracentesis with cytology and contemporaneous FDG-PET were identified for analysis. Some underwent confirmatory pleural biopsy. The uptake pattern on FDG-PET underwent blinded review and was categorized based on the pattern of uptake. RESULTS One hundred consecutive patients with confirmed malignancy, suspected MPE and corresponding FDG-PET scans were reviewed. MPE was confirmed in 70 patients with positive pleural fluid cytology or tissue pathology. Of the remaining patients, 15 had negative cytopathology, 14 had atypical cells and 1 had reactive cells. Positive uptake on FDG-PET was noted in 76 patients. The concordance of malignant histology and positive FDG-PET occurred in 58 of 76 patients (76%). Combining histologically confirmed MPE with atypical cytology, positive pleural FDG-PET uptake had a positive predictive value of 91% for MPE. An encasement pattern had a 100% PPV for malignancy. CONCLUSION Positive FDG-PET pleural uptake represents an excellent method to identify MPE, especially in patients with an encasement pattern. This may eliminate the need for additional invasive procedures in some patients, even when initial pleural cytology is negative.
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Affiliation(s)
| | - Jaime Betancourt
- West Los Angeles Veterans Affairs Healthcare Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA; (J.B.); (G.W.S.H.)
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
| | - Guy W. Soo Hoo
- West Los Angeles Veterans Affairs Healthcare Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA; (J.B.); (G.W.S.H.)
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
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Whitfield HJ, Berthelet J, Mangiola S, Bell C, Anderson RL, Pal B, Yeo B, Papenfuss AT, Merino D, Davis MJ. Single-cell RNA sequencing captures patient-level heterogeneity and associated molecular phenotypes in breast cancer pleural effusions. Clin Transl Med 2023; 13:e1356. [PMID: 37691350 PMCID: PMC10493486 DOI: 10.1002/ctm2.1356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Malignant pleural effusions (MPEs) are a common complication of advanced cancers, particularly those adjacent to the pleura, such as lung and breast cancer. The pathophysiology of MPE formation remains poorly understood, and although MPEs are routinely used for the diagnosis of breast cancer patients, their composition and biology are poorly understood. It is difficult to distinguish invading malignant cells from resident mesothelial cells and to identify the directionality of interactions between these populations in the pleura. There is a need to characterize the phenotypic diversity of breast cancer cell populations in the pleural microenvironment, and investigate how this varies across patients. METHODS Here, we used single-cell RNA-sequencing to study the heterogeneity of 10 MPEs from seven metastatic breast cancer patients, including three Miltenyi-enriched samples using a negative selection approach. This dataset of almost 65 000 cells was analysed using integrative approaches to compare heterogeneous cell populations and phenotypes. RESULTS We identified substantial inter-patient heterogeneity in the composition of cell types (including malignant, mesothelial and immune cell populations), in expression of subtype-specific gene signatures and in copy number aberration patterns, that captured variability across breast cancer cell populations. Within individual MPEs, we distinguished mesothelial cell populations from malignant cells using key markers, the presence of breast cancer subtype expression patterns and copy number aberration patterns. We also identified pleural mesothelial cells expressing a cancer-associated fibroblast-like transcriptomic program that may support cancer growth. CONCLUSIONS Our dataset presents the first unbiased assessment of breast cancer-associated MPEs at a single cell resolution, providing the community with a valuable resource for the study of MPEs. Our work highlights the molecular and cellular diversity captured in MPEs and motivates the potential use of these clinically relevant biopsies in the development of targeted therapeutics for patients with advanced breast cancer.
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Affiliation(s)
- Holly J. Whitfield
- Department of Medical Biology, The Faculty of MedicineDentistry and Health Science, The University of MelbourneCarltonVictoriaAustralia
- Bioinformatics DivisionThe Walter and Eliza Hall Institute of Medical ResearchParkvilleVictoriaAustralia
| | - Jean Berthelet
- Olivia Newton‐John Cancer Research InstituteHeidelbergVictoriaAustralia
- School of Cancer MedicineLa Trobe UniversityBundooraVictoriaAustralia
| | - Stefano Mangiola
- Department of Medical Biology, The Faculty of MedicineDentistry and Health Science, The University of MelbourneCarltonVictoriaAustralia
- Bioinformatics DivisionThe Walter and Eliza Hall Institute of Medical ResearchParkvilleVictoriaAustralia
| | - Caroline Bell
- Olivia Newton‐John Cancer Research InstituteHeidelbergVictoriaAustralia
- School of Cancer MedicineLa Trobe UniversityBundooraVictoriaAustralia
| | - Robin L. Anderson
- Olivia Newton‐John Cancer Research InstituteHeidelbergVictoriaAustralia
- School of Cancer MedicineLa Trobe UniversityBundooraVictoriaAustralia
- Peter MacCallum Cancer CentreParkvilleVictoriaAustralia
- Department of Clinical Pathology, Faculty of MedicineDentistry and Health Science, The University of MelbourneCarltonVictoriaAustralia
| | - Bhupinder Pal
- Olivia Newton‐John Cancer Research InstituteHeidelbergVictoriaAustralia
- School of Cancer MedicineLa Trobe UniversityBundooraVictoriaAustralia
| | - Belinda Yeo
- Olivia Newton‐John Cancer Research InstituteHeidelbergVictoriaAustralia
- School of Cancer MedicineLa Trobe UniversityBundooraVictoriaAustralia
- Austin HealthHeidelbergVictoriaAustralia
| | - Anthony T. Papenfuss
- Department of Medical Biology, The Faculty of MedicineDentistry and Health Science, The University of MelbourneCarltonVictoriaAustralia
- Bioinformatics DivisionThe Walter and Eliza Hall Institute of Medical ResearchParkvilleVictoriaAustralia
- Department of Clinical Pathology, Faculty of MedicineDentistry and Health Science, The University of MelbourneCarltonVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneCarltonVictoriaAustralia
| | - Delphine Merino
- Department of Medical Biology, The Faculty of MedicineDentistry and Health Science, The University of MelbourneCarltonVictoriaAustralia
- Olivia Newton‐John Cancer Research InstituteHeidelbergVictoriaAustralia
- School of Cancer MedicineLa Trobe UniversityBundooraVictoriaAustralia
- Immunology DivisionThe Walter and Eliza Hall Institute of Medical ResearchParkvilleVictoriaAustralia
| | - Melissa J. Davis
- Department of Medical Biology, The Faculty of MedicineDentistry and Health Science, The University of MelbourneCarltonVictoriaAustralia
- Bioinformatics DivisionThe Walter and Eliza Hall Institute of Medical ResearchParkvilleVictoriaAustralia
- Department of Clinical Pathology, Faculty of MedicineDentistry and Health Science, The University of MelbourneCarltonVictoriaAustralia
- The University of Queensland Diamantina InstituteThe University of QueenslandBrisbaneQueenslandAustralia
- The South Australian Immunogenomics Cancer InstituteThe University of AdelaideAdelaideSouth AustraliaAustralia
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Chan C, Sekowski V, Zheng B, Li P, Stollery D, Veenstra J, Gillson AM. Combination Tissue Plasminogen Activator and DNase for Loculated Malignant Pleural Effusions: A Single-center Retrospective Review. J Bronchology Interv Pulmonol 2023; 30:238-243. [PMID: 35698287 PMCID: PMC10312901 DOI: 10.1097/lbr.0000000000000871] [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: 10/27/2021] [Accepted: 04/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Indwelling pleural catheters (IPCs) are frequently used for the management of malignant pleural effusions (MPEs), but drainage can be impaired by pleural loculations. We aimed to evaluate the safety and effectiveness of intrapleural tissue plasminogen activator (tPA) versus combination tPA-deoxyribonuclease (DNase) in the treatment of loculated MPE. METHODS We performed a retrospective review of patients with confirmed or presumed MPEs requiring IPC insertion. We compared the efficacy of intrapleural tPA, tPA-DNase, and procedural intervention on pleural fluid drainage. Secondary endpoints included the need for future pleural procedures (eg, thoracentesis, IPC reinsertion, chest tube insertion, or surgical intervention), IPC removal due to spontaneous pleurodesis, and IPC-related complications. RESULTS Among 437 patients with MPEs, loculations developed in 81 (19%) patients. Twenty-four (30%) received intrapleural tPA, 46 (57%) received intrapleural tPA-DNase, 4 (5%) underwent a procedural intervention, and 7 (9%) received ongoing medical management. tPA improved pleural drainage in 83% of patients, and tPA-DNase improved pleural drainage in 80% of patients. tPA alone may be associated with increased rates of spontaneous pleurodesis compared with tPA-DNase. There was no difference in complications when comparing tPA, combination tPA-DNase, procedural intervention, and no therapy. CONCLUSION Both intrapleural tPA and combination tPA-DNase appear to be safe and effective in improving pleural fluid drainage in selected patients with loculated MPE, although further studies are needed.
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Affiliation(s)
| | | | - Bo Zheng
- Department of Medicine, Western University, London, ON, Canada
| | - Pen Li
- Department of Medicine, University of Alberta
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Han R, Huang L, Zhou S, Shen J, Li P, Li M, Wu X, Wang R. Novel clinical radiomic nomogram method for differentiating malignant from non-malignant pleural effusions. Heliyon 2023; 9:e18056. [PMID: 37539225 PMCID: PMC10395353 DOI: 10.1016/j.heliyon.2023.e18056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 08/05/2023] Open
Abstract
Objectives To establish a clinical radiomics nomogram that differentiates malignant and non-malignant pleural effusions. Methods A total of 146 patients with malignant pleural effusion (MPE) and 93 patients with non-MPE (NMPE) were included. The ROI image features of chest lesions were extracted using CT. Univariate analysis was performed, and least absolute shrinkage selection operator and multivariate logistic analysis were used to screen radiomics features and calculate the radiomics score. A nomogram was constructed by combining clinical factors with radiomics scores. ROC curve and decision curve analysis (DCA) were used to evaluate the prediction effect. Results After screening, 19 radiomics features and 2 clinical factors were selected as optimal predictors to establish a combined model and construct a nomogram. The AUC of the combined model was 0.968 (95% confidence interval [CI] = 0.944-0.986) in the training cohort and 0.873 (95% CI = 0.796-0.940) in the validation cohort. The AUC value of the combined model was significantly higher than those of the clinical and radiomics models (0.968 vs. 0.874 vs. 0.878, respectively). This was similar in the validation cohort (0.873, 0.764, and 0.808, respectively). DCA confirmed the clinical utility of the radiomics nomogram. Conclusion CT-based radiomics showed better diagnostic accuracy and model fit than clinical and radiological features in distinguishing MPE from NMPE. The combination of both achieved better diagnostic performance. These findings support the clinical application of the nomogram in diagnosing MPE using chest CT.
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Affiliation(s)
- Rui Han
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Ling Huang
- Department of Infectious Disease, Hefei Second People's Hospital, Hefei, 230001, China
| | - Sijing Zhou
- Department of Occupational Disease, Hefei Third Clinical College of Anhui Medical University, Hefei, 230022, China
| | - Jiran Shen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Pulin Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Min Li
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Xingwang Wu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Ran Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
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MacRosty CR, Wright A, Ceppe A, Ghosh S, Burks AC, Akulian JA. Pleural Fluid Resolution Is Associated with Improved Survival in Patients with Malignant Pleural Effusion. Life (Basel) 2023; 13:life13051163. [PMID: 37240808 DOI: 10.3390/life13051163] [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: 03/24/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Malignant pleural effusion is associated with a poor prognosis and, while risk stratification models exist, prior studies have not evaluated pleural fluid resolution and its association with survival. We performed a retrospective review of patients diagnosed with malignant pleural effusion between 2013 and 2017, evaluating patient demographics, pleural fluid and serum composition, and procedural and treatment data using Cox regression analysis to evaluate associations with survival. In total, 123 patients were included in the study, with median survival from diagnosis being 4.8 months. Resolution of malignant pleural fluid was associated with a significant survival benefit, even when accounting for factors such as placement of an indwelling pleural catheter, anti-cancer therapy, pleural fluid cytology, cancer pheno/genotypes, and pleural fluid characteristics. Elevated fluid protein, placement of an indwelling pleural catheter, and treatment with targeted or hormone therapies were associated with pleural fluid resolution. We conclude that the resolution of pleural fluid accumulation in patients with malignant pleural effusion is associated with a survival benefit possibility representing a surrogate marker for treatment of the underlying metastatic cancer. These findings support the need to better understand the mechanism of fluid resolution in patients with malignant pleural effusion as well as the tumor-immune interplay occurring with the malignant pleural space.
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Affiliation(s)
- Christina R MacRosty
- Section of Interventional Pulmonology and Pulmonary Oncology, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Carolina Center for Pleural Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Amber Wright
- Section of Interventional Pulmonology and Pulmonary Oncology, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Agathe Ceppe
- Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sohini Ghosh
- Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, PA 15222, USA
| | - A Cole Burks
- Section of Interventional Pulmonology and Pulmonary Oncology, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Carolina Center for Pleural Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jason A Akulian
- Section of Interventional Pulmonology and Pulmonary Oncology, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Carolina Center for Pleural Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Samadi Takaldani AH, Javanshir N, Negaresh M, Honardoost H. A Case of Acute Respiratory Distress Syndrome Following Pleurodesis With Talc. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231170196. [PMID: 37124843 PMCID: PMC10134139 DOI: 10.1177/11795476231170196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023]
Abstract
Management of malignant pleural effusion is a medical challenge, and several methods have been proposed to deal with it including thoracentesis, indwelling pleural catheter placement, and chemical or mechanical pleurodesis. Each method, however, has its advantages and disadvantages. Talc pleurodesis is generally recognized as the most effective and safest method for the induction of chemical pleurodesis. However, in rare cases, it can lead to acute respiratory distress syndrome (ARDS). In this article, we report the case of a patient with metastatic adenocarcinoma to the pleura who presents with shortness of breath and malignant pleural effusion, develops ARDS after pleurodesis with talc, and expires despite the partial improvement of lung involvement. The symptoms and causes of this rare side effect as well as the methods that can be used to deal with it are reviewed in this article.
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Affiliation(s)
- Ali Hossein Samadi Takaldani
- Department of Internal Medicine (Pulmonology Division), School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nima Javanshir
- Faculty of Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Negaresh
- Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
- Mohammad Negaresh, Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Helia Honardoost
- Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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Chintala NK, Choe JK, McGee E, Bellis R, Saini JK, Banerjee S, Moreira AL, Zauderer MG, Adusumilli PS, Rusch VW. Correlative analysis from a phase I clinical trial of intrapleural administration of oncolytic vaccinia virus (Olvi-vec) in patients with malignant pleural mesothelioma. Front Immunol 2023; 14:1112960. [PMID: 36875061 PMCID: PMC9977791 DOI: 10.3389/fimmu.2023.1112960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
Background The attenuated, genetically engineered vaccinia virus has been shown to be a promising oncolytic virus for the treatment of patients with solid tumors, through both direct cytotoxic and immune-activating effects. Whereas systemically administered oncolytic viruses can be neutralized by pre-existing antibodies, locoregionally administered viruses can infect tumor cells and generate immune responses. We conducted a phase I clinical trial to investigate the safety, feasibility and immune activating effects of intrapleural administration of oncolytic vaccinia virus (NCT01766739). Methods Eighteen patients with malignant pleural effusion due to either malignant pleural mesothelioma or metastatic disease (non-small cell lung cancer or breast cancer) underwent intrapleural administration of the oncolytic vaccinia virus using a dose-escalating method, following drainage of malignant pleural effusion. The primary objective of this trial was to determine a recommended dose of attenuated vaccinia virus. The secondary objectives were to assess feasibility, safety and tolerability; evaluate viral presence in the tumor and serum as well as viral shedding in pleural fluid, sputum, and urine; and evaluate anti-vaccinia virus immune response. Correlative analyses were performed on body fluids, peripheral blood, and tumor specimens obtained from pre- and post-treatment timepoints. Results Treatment with attenuated vaccinia virus at the dose of 1.00E+07 plaque-forming units (PFU) to 6.00E+09 PFU was feasible and safe, with no treatment-associated mortalities or dose-limiting toxicities. Vaccinia virus was detectable in tumor cells 2-5 days post-treatment, and treatment was associated with a decrease in tumor cell density and an increase in immune cell density as assessed by a pathologist blinded to the clinical observations. An increase in both effector (CD8+, NK, cytotoxic cells) and suppressor (Tregs) immune cell populations was observed following treatment. Dendritic cell and neutrophil populations were also increased, and immune effector and immune checkpoint proteins (granzyme B, perforin, PD-1, PD-L1, and PD-L2) and cytokines (IFN-γ, TNF-α, TGFβ1 and RANTES) were upregulated. Conclusion The intrapleural administration of oncolytic vaccinia viral therapy is safe and feasible and generates regional immune response without overt systemic symptoms. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT01766739, identifier NCT01766739.
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Affiliation(s)
- Navin K Chintala
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jennie K Choe
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Erin McGee
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Rebecca Bellis
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jasmeen K Saini
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Srijita Banerjee
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andre L Moreira
- Department of Pathology, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Marjorie G Zauderer
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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11
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Martinez-Zayas G, Molina S, Ost DE. Sensitivity and complications of thoracentesis and thoracoscopy: a meta-analysis. Eur Respir Rev 2022; 31:31/166/220053. [PMID: 36543349 PMCID: PMC9879342 DOI: 10.1183/16000617.0053-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/31/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Thoracentesis and thoracoscopy are used to diagnose malignant pleural effusions (MPE). Data on how sensitivity varies with tumour type is limited. METHODS Systematic review using PubMed was performed through August 2020 to determine the sensitivity of thoracentesis and thoracoscopy for MPE secondary to malignancy, by cancer type, and complication rates. Tests to identify sources of heterogeneity were performed. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and National Institutes of Health quality assessment tools. Publication bias was tested using funnel plots. RESULTS Meta-analyses for sensitivity of thoracentesis for MPE secondary to malignancy, mesothelioma and lung and breast cancer included 29, eight, 12 and nine studies, respectively. Pooled sensitivities were 0.643 (95% CI 0.592-0.692), 0.451 (95% CI 0.249-0.661), 0.738 (95% CI 0.659-0.836) and 0.820 (95% CI 0.700-0.917), respectively. For sensitivity of thoracoscopy for MPE secondary to malignancy and mesothelioma, 41 and 15 studies were included, respectively. Pooled sensitivities were 0.929 (95% CI 0.905-0.95) and 0.915 (95% CI 0.871-0.952), respectively. Pooled complication rates of thoracentesis and thoracoscopy were 0.041 (95% CI 0.025-0.051) and 0.040 (95% CI 0.029-0.052), respectively. Heterogeneity was significant for all meta-analyses. Funnel plots were asymmetric. INTERPRETATION Sensitivity of thoracentesis varied significantly per cancer type. Pooled complication rates were low. Awareness of how sensitivity of thoracentesis changes across cancers can improve decision-making when MPE is suspected.
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Affiliation(s)
- Gabriela Martinez-Zayas
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Centre, Houston, TX, USA
| | - Sofia Molina
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Centre, Houston, TX, USA
| | - David E. Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Centre, Houston, TX, USA,Corresponding author: David E. Ost ()
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12
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Kolokotroni SM, Lamprinos D, Goutas N, Kapetanakis EI, Kontzoglou K, Perrea D, Tomos P. Platelet-Rich Plasma for Pleurodesis: An Experimental Study in Rabbits. Medicina (B Aires) 2022; 58:medicina58121842. [PMID: 36557044 PMCID: PMC9785005 DOI: 10.3390/medicina58121842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background and Objectives: This study was designed to evaluate platelet-rich plasma (PRP) as a method of pleurodesis in a rabbit model. Pleurodesis with PRP was compared against the gold-standard use of talc. The secondary evaluation assessed the ideal time for achieving pleurodesis. Materials and Methods: 25 healthy New Zealand white rabbits were assigned to three groups, as follows: 12 animals in the first and second groups, as well as one animal with no intervention in the final group, which was used as a control. The talc pleurodesis group (baseline) underwent pleurodesis with sterile talc, which is the gold-standard sclerosing agent used for pleurodesis. The PRP group underwent pleurodesis using autologous PRP. The last group had one rabbit with no intervention. A total of 12 rabbits (n = 6 for the talc pleurodesis group and n = 6 for the PRP group) were sacrificed 3 days (72 h) after the intervention, and 12 rabbits (n = 6 for the talc pleurodesis group and n = 6 for the PRP group) were sacrificed 6 days (144 h) after the intervention. In both the talc and PRP group, FBC and CRP were measured before the intervention and in 3 or 6 days afterwards, respectively. The pleura and the lungs were evaluated histopathologically. Results: Macroscopically, there were no statistically significant differences between the two groups. In terms of microscopic findings, there were no statistically significant differences in inflammatory reactions provoked in the visceral and parietal pleura between the PRP and talc. In addition, with talc pleurodesis, a foreign-body reaction was observed in about 50% of the cases, which was not observed with PRP. In terms of inflammation between 3 and 6 days, there were no statistically significant differences with PRP, there was only a statistically significant difference between 3 and 6 days regarding the parietal pleura in the talc group. Conclusions: The instillation of autologous PRP in the pleural cavity shows promise in achieving pleurodesis. The efficacy of PRP as a pleurodesis agent should be examined further.
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Affiliation(s)
- Styliani Maria Kolokotroni
- Department of Cardiothoracic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Laboratory of Experimental Surgery and Surgical Research “N. S. Christeas”, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence:
| | | | - Nikolaos Goutas
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Emmanouil I. Kapetanakis
- Department of Thoracic Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Konstantinos Kontzoglou
- Laboratory of Experimental Surgery and Surgical Research “N. S. Christeas”, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Despoina Perrea
- Laboratory of Experimental Surgery and Surgical Research “N. S. Christeas”, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Periklis Tomos
- Department of Thoracic Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
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13
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Abstract
Malignant pleural effusions are common in patients with cancer. Most malignant pleural effusions are secondary to metastases to the pleura, most often from lung or breast cancer. The presence of malignant effusion indicates advanced disease and poor survival; in lung cancer, the presence of malignant effusion upstages the cancer to stage 4. Usually presenting as a large, unilateral exudative effusion, most patients with malignant pleural effusion experience dyspnea. Prior to intervention, diagnosis of malignant pleural effusion and exclusion of infection should be made. Thoracic imaging is typically performed, with computed tomography considered by many to be the gold standard. Thoracic ultrasound is also useful, particularly if diaphragmatic or pleural thickening and nodularity can be identified. Cytology should then be obtained; this is typically done via pleural fluid aspiration or pleural biopsy. Treatment focuses on palliation and relief of symptoms. Numerous interventions are available, ranging from drainage with thoracentesis or indwelling pleural catheter to more definitive, invasive options such as pleurodesis. There is no clear best approach, and a patient-centered approach should be taken.
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Affiliation(s)
- Shameek Gayen
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa.
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14
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Hofmann HS, M. Scheule A, Markowiak T, Ried M. The Treatment of Malignant Pleural Effusion With Permanent Indwelling Pleural Catheters. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:595-600. [PMID: 35734918 PMCID: PMC9749840 DOI: 10.3238/arztebl.m2022.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND 40 000 to 60 000 people develop malignant pleural effusion (MPE) in Germany each year. The most common causes are lung cancer and breast cancer. Patients with pleural carcinomatosis have a median survival time of four months. METHODS We investigated the current health services situation regarding treatment with indwelling pleural catheters (IPC) versus talc pleurodesis (TP) in Germany based on registry data from the Federal Statistical Office, the Pleural Tumor Registry of the German Society for Thoracic Surgery, and the IPC registry of the ewimed GmbH company. In addition, we conducted a selective literature review on IPC and TP. RESULTS The symptoms of dyspnea and thoracic pressure determine the need for therapy in MPE. Both TP and IPC are effective treatment options for MPE. Both therapeutic procedures are considered equally effective with respect to the relief of dyspnea, post-interventional quality of life, and complication rates. TP yields a higher rate of successful pleurodesis than IPC (relative risk: 1.56; 95% confidence interval: [1.26; 1.92]; p < 0.0001), while patients who receive an IPC stay in the hospital for a shorter time than those who undergo TP (a difference of slightly more than two days). The survival of patients with MPE is not affected by which of the two local therapeutic procedures is chosen. CONCLUSION The indication for either IPC or TP needs to be determined individually for each patient on the basis of his or her general condition, symptoms, clinical situation ("trapped lung"), and prognosis.
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Affiliation(s)
- Hans-Stefan Hofmann
- University Hospital Regensburg, Department of Thoracic Surgery,*Department for Thoracic Surgery University Hospital of Regensburg Franz-Josef-Strauss-Allee 11 93053 Regensburg
| | | | - Till Markowiak
- University Hospital Regensburg, Department of Thoracic Surgery
| | - Michael Ried
- University Hospital Regensburg, Department of Thoracic Surgery
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15
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Uncovering Objective Improvements in Physical Activity Using Digital Actigraphy after Therapeutic Thoracentesis: A Pilot Study. Ann Am Thorac Soc 2022; 19:1438-1440. [PMID: 35587360 DOI: 10.1513/annalsats.202202-165rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Jha S, Sethy M, Sharma G, Adhya AK. Adequacy in pleural effusion: What is the minimum volume required for detection of malignant cells? Diagn Cytopathol 2022; 50:284-288. [PMID: 35362266 DOI: 10.1002/dc.24959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adequacy criteria of pleural fluid volume for optimal reporting are contentious, and very little literature is available to date. This problem has not been addressed in the novel International System for Reporting Serous Fluid Cytology. MATERIALS AND METHODS A retrospective analysis was performed on 939 pleural fluid samples. Five volume bins were created: 0-9.9 ml, 10-19.9 ml, 20-34.9 ml, 35-69.9 ml, and > 70 ml and included 203, 222, 314, 174, and 26 samples, respectively. Volume bins were compared across various categories using a Chi-square test. A malignancy fraction was used to assess diagnostic accuracy. Descriptive statistics for categorical variables were done with median and interquartile range. A ROC curve was constructed to find if pleural fluid volume can be used to detect malignancy. A cut-off volume was found which can detect malignancy with optimum sensitivity. RESULTS The area under the Receiver Operating Characteristic curve showed that 55% of the time, the pleural volume can detect malignancy correctly. From the coordinates of the curve it was found that for a sensitivity of 81% and specificity of 40%, a cut-off volume of 13.5 ml of pleural fluid is sufficient to detect malignancy. CONCLUSIONS We recommend 13.5 ml as the minimum volume cut-off for a satisfactory pleural effusion cytology report. Below this volume, the false-negative rates increase, and the specimen may be deemed as limited for a conclusive diagnosis. As the volume rises above this threshold volume, the false negativity rate decreases but does not significantly improve malignant cells' detection.
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Affiliation(s)
- Shilpy Jha
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Madhusmita Sethy
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Gaurav Sharma
- Department of Preventive & Social Dentistry, SCB Dental College & Hospital, Cuttack, India
| | - Amit Kumar Adhya
- Department of Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
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17
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Liu Y, Zhao D. A novel nano-immunotherapeutic remodels the immune landscape of malignant pleural effusion: Insights into its mechanism of action through single-cell RNA-sequencing. Clin Transl Med 2022; 12:e774. [PMID: 35297203 PMCID: PMC8926894 DOI: 10.1002/ctm2.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022] Open
Abstract
Clinical evidence indicates that the microenvironment in malignant pleural effusion (MPE) is immunologically cold, which impairs tumour immunosurveillance and antitumor immune response to immune checkpoint blockade (ICB). In a recent issue of Nature Nanotechnology, Liu et al. demonstrate a new nanotechnological approach to effectively mitigate the immune cold MPE and provide insights into its mechanism of action through single-cell RNA-sequencing.
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Affiliation(s)
- Yang Liu
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Dawen Zhao
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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18
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Chian CF, Wu FP, Tsai CL, Peng CK, Shen CH, Perng WC, Hsu SC. Echogenic swirling pattern, carcinoembryonic antigen, and lactate dehydrogenase in the diagnosis of malignant pleural effusion. Sci Rep 2022; 12:4077. [PMID: 35260758 PMCID: PMC8904853 DOI: 10.1038/s41598-022-08188-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/01/2022] [Indexed: 12/16/2022] Open
Abstract
The echogenic swirling pattern has a role in predicting malignant pleural effusion (MPE). However, its predictive ability is suboptimal, and its clinical utility remains to be defined. The aim of this study was to assess the diagnostic potential of the echogenic swirling pattern combined with pleural carcinoembryonic antigen (CEA) and routine laboratory tests of pleural effusion in MPE. The 80 consecutive patients with underlying malignancy and pleural effusions were recruited. All patients underwent one diagnostic thoracentesis with a cytologic examination of pleural fluid. Our study showed that the sensitivity of echogenic swirling patterns in MPE diagnosis was 67.7%, specificity was 72.2%, positive predictive value (PPV) was 89.4%, and negative predictive value (NPV) was 39.4%. Both CEA and lactate dehydrogenase (LDH) had acceptable sensitivity (71.0% and 60.7%) and specificity (72.2% and 77.8%). Combining the echogenic swirling pattern, pleural CEA, and pleural LDH, the highest sensitivity (95.2%) with a good PPV (86.8) was reached. In this clinical study, we found that combining the echogenic swirling pattern, pleural CEA, and pleural LDH had a higher sensitivity and a high positive predictive value for the diagnosis of MPE. This combination is a potentially suitable method for MPE screening in cancer patients with pleural effusions.
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Affiliation(s)
- Chih-Feng Chian
- Division of Pulmonary and Critical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Fu-Ping Wu
- Hsiao Chung-Cheng Hospital, New Taipei City, Taiwan, ROC
| | - Chen-Liang Tsai
- Division of Pulmonary and Critical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Hyperbaric Oxygen Therapy Center, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chih-Hao Shen
- Division of Pulmonary and Critical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wann-Cherng Perng
- Division of Pulmonary and Critical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shih-Chang Hsu
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC. .,Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, No.250, Wuxing St., 11031, Taipei, Taiwan.
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19
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Donnenberg VS, Wagner PL, Luketich JD, Bartlett DL, Donnenberg AD. Localized Intra-Cavitary Therapy to Drive Systemic Anti-Tumor Immunity. Front Immunol 2022; 13:846235. [PMID: 35222439 PMCID: PMC8873820 DOI: 10.3389/fimmu.2022.846235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/20/2022] [Indexed: 11/19/2022] Open
Abstract
Metastasis to the pleural and peritoneal cavities is a common terminal pathway for a wide variety of cancers. This article explores how these unique environments both promote aggressive tumor behavior and suppresses anti-tumor immunity, and ways in which local delivery of protein therapeutics can leverage the contained nature of these spaces to a therapeutic advantage, achieving high intra-cavital concentrations while minimizing systemic toxicity.
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Affiliation(s)
- Vera S. Donnenberg
- University of Pittsburgh Medical Center (UPMC) Hillman Cancer Centers, Pittsburgh, PA, United States
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA, United States
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Patrick L. Wagner
- Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, United States
- College of Medicine, Drexel University, Pittsburgh, PA, United States
| | - James D. Luketich
- University of Pittsburgh Medical Center (UPMC) Hillman Cancer Centers, Pittsburgh, PA, United States
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - David L. Bartlett
- Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, United States
- College of Medicine, Drexel University, Pittsburgh, PA, United States
| | - Albert D. Donnenberg
- University of Pittsburgh Medical Center (UPMC) Hillman Cancer Centers, Pittsburgh, PA, United States
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA, United States
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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20
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Liu Y, Wang L, Song Q, Ali M, Crowe WN, Kucera GL, Hawkins GA, Soker S, Thomas KW, Miller LD, Lu Y, Bellinger CR, Zhang W, Habib AA, Petty WJ, Zhao D. Intrapleural nano-immunotherapy promotes innate and adaptive immune responses to enhance anti-PD-L1 therapy for malignant pleural effusion. NATURE NANOTECHNOLOGY 2022; 17:206-216. [PMID: 34916656 PMCID: PMC9074399 DOI: 10.1038/s41565-021-01032-w] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/12/2021] [Indexed: 05/02/2023]
Abstract
Malignant pleural effusion (MPE) is indicative of terminal malignancy with a uniformly fatal prognosis. Often, two distinct compartments of tumour microenvironment, the effusion and disseminated pleural tumours, co-exist in the pleural cavity, presenting a major challenge for therapeutic interventions and drug delivery. Clinical evidence suggests that MPE comprises abundant tumour-associated myeloid cells with the tumour-promoting phenotype, impairing antitumour immunity. Here we developed a liposomal nanoparticle loaded with cyclic dinucleotide (LNP-CDN) for targeted activation of stimulators of interferon genes signalling in macrophages and dendritic cells and showed that, on intrapleural administration, they induce drastic changes in the transcriptional landscape in MPE, mitigating the immune cold MPE in both effusion and pleural tumours. Moreover, combination immunotherapy with blockade of programmed death ligand 1 potently reduced MPE volume and inhibited tumour growth not only in the pleural cavity but also in the lung parenchyma, conferring significantly prolonged survival of MPE-bearing mice. Furthermore, the LNP-CDN-induced immunological effects were also observed with clinical MPE samples, suggesting the potential of intrapleural LNP-CDN for clinical MPE immunotherapy.
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Affiliation(s)
- Yang Liu
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lulu Wang
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Qianqian Song
- Center for Cancer Genomics and Precision Oncology, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Muhammad Ali
- Department of Pulmonary and Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - William N Crowe
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gregory L Kucera
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gregory A Hawkins
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Shay Soker
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Karl W Thomas
- Department of Pulmonary and Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lance D Miller
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Yong Lu
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christina R Bellinger
- Department of Pulmonary and Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Wei Zhang
- Center for Cancer Genomics and Precision Oncology, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amyn A Habib
- Department of Neurology, University of Texas Southwestern Medical Center and VA North Texas Medical Center, Dallas, TX, USA
| | - W Jeffrey Petty
- Department of Medicine, Section on hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dawen Zhao
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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21
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Liu L, Xiong X. Clinicopathologic Features and Molecular Biomarkers as Predictors of Epidermal Growth Factor Receptor Gene Mutation in Non-Small Cell Lung Cancer Patients. Curr Oncol 2021; 29:77-93. [PMID: 35049681 PMCID: PMC8774362 DOI: 10.3390/curroncol29010007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022] Open
Abstract
Lung cancer ranks first in the incidence and mortality of cancer in the world, of which more than 80% are non-small cell lung cancer (NSCLC). The majority of NSCLC patients are in stage IIIB~IV when they are admitted to hospital and have no opportunity for surgery. Compared with traditional chemotherapy, specific targeted therapy has a higher selectivity and fewer adverse reactions, providing a new treatment direction for advanced NSCLC patients. Tyrosine kinase inhibitors of epidermal growth factor receptor (EGFR-TKIs) are the widely used targeted therapy for NSCLC patients. Their efficacy and prognosis are closely related to the mutation status of the EGFR gene. Clinically, detecting EGFR gene mutation is often limited by difficulty obtaining tissue specimens, limited detecting technology, and economic conditions, so it is of great clinical significance to find indicators to predict EGFR gene mutation status. Clinicopathological characteristics, tumor markers, liquid biopsy, and other predictors are less invasive, economical, and easier to obtain. They can be monitored in real-time, which is supposed to predict EGFR mutation status and provide guidance for the accurate, individualized diagnosis and therapy of NSCLC patients. This article reviewed the correlation between the clinical indicators and EGFR gene mutation status in NSCLC patients.
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22
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Abstract
Malignant pleural effusions have a significant burden on patients and the health care system. Diagnosis is typically via thoracentesis, although other times more invasive procedures are required. Management centers around relief of dyspnea and patient quality of life and can be done via serial thoracentesis, indwelling pleural catheter, or pleurodesis. This article focuses on the diagnosis and management of malignant pleural effusion.
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Affiliation(s)
- Christopher M Kapp
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Illinois at Chicago, 840 South Wood Street, Room 920-N, Chicago, IL 60612, USA.
| | - Hans J Lee
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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23
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Setting up a Pleural Disease Service. Clin Chest Med 2021; 42:611-623. [PMID: 34774169 DOI: 10.1016/j.ccm.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Pleural disease incidence is continuing to rise internationally and management is becoming increasingly complex. There are now many more options for patients, with access to thoracic ultrasound, image-guided biopsies, indwelling pleural catheters, and local-anesthetic pleuroscopy (thoracoscopy). Safety reports have also highlighted the need for specialist operator knowledge and skill. Consequently, the development of a specialized pleural service can manage patients entirely as an outpatient, limit the number of procedures, and improve patient safety, it also fosters opportunities to enhance specialist procedural skills, engage in clinical research, and reduce the costs of care.
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24
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Abstract
Recurrent, symptomatic pleural effusions are common and can contribute to significant morbidity in affected patients. Various management options are available and indwelling pleural catheter placement is becoming more commonplace and is the preferred option in certain clinical scenarios. The body of literature pertaining to indwelling pleural catheter use has grown substantially over the last decade and the purpose of this review is to summarize the best available evidence.
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Affiliation(s)
- Audra J Schwalk
- Division of Pulmonary and Critical Care, The University of Texas Southwestern Medical Center, Professional Office Building II, 5939 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Unit 1462, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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25
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Aqeel M, Medhora M, Gore E, Borkenhagen J, Klawikowski S, Eastwood D, Banerjee A, Jacobs ER. Evaluation of Radiation-induced Pleural Effusions after Radiotherapy to Support Development of Animal Models of Radiation Pneumonitis. HEALTH PHYSICS 2021; 121:434-443. [PMID: 34546223 PMCID: PMC8500166 DOI: 10.1097/hp.0000000000001462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
ABSTRACT Not all animal models develop radiation-induced pleural effusions (RIPEs) as a form of radiation-induced lung injury (RILI). Such effusions are also not well characterized in humans. The purpose of this study is to identify occurrences of RIPE in humans, provide justification for development of relevant animal models, and further characterize its risk factors in cancer patients. We also aim to identify dose thresholds for cardiopulmonary toxicity in humans to shed light on possible pathogenic mechanisms for RIPEs. We carried out a retrospective review of medical records of 96 cancer patients receiving thoracic irradiation (TRT) at our institution. Fifty-three (53%) patients developed a new pleural effusion post TRT; 18 (19%) had RIPE; and 67% developed RIPE ipsilateral to the site irradiated. None developed "contralateral only" effusions. Median time to development was 6 mo (IQR; 4-8 mo). Of 18, 8 patients (44%) had concomitant asymptomatic (radiographic only) or symptomatic radiation pneumonitis and pericardial effusion. Dosimetric factors, including combined and ipsilateral mean lung dose (MLD), were significantly associated with increased risk of RIPE. Angiotensin converting enzyme inhibition, steroids, or concurrent chemotherapy did not modify incidence of RIPE. Our results substantiate the occurrence and incidence of RIPEs in humans. In cancer patients, a median time to development of effusions around 6 mo also supports the onset of RIPEs concurrent with radiation pneumonitis. Future work needs to include large populations of cancer survivors in whom delayed RIPEs can be tracked and correlated with cardiovascular changes in the context of injury to multiple organs.
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Affiliation(s)
- Masooma Aqeel
- Current Affiliation: Section of Pulmonary & Critical
Care Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan.
Formerly at Division of Pulmonary Medicine, Department of Medicine, Froedtert
Hospital & Medical College of Wisconsin, Milwaukee, WI, United States
| | - Meetha Medhora
- Division of Pulmonary Medicine, Department of Medicine,
Froedtert Hospital & Medical College of Wisconsin, Milwaukee, WI, United
States
- Department of Radiation Oncology, Froedtert Hospital &
Medical College of Wisconsin, Milwaukee, WI, United States
- Research Service, Department of Veteran’s Affairs,
Clement J. Zablocki VA Medical Center, Milwaukee, WI, United States
| | - Elizabeth Gore
- Department of Radiation Oncology, Froedtert Hospital &
Medical College of Wisconsin, Milwaukee, WI, United States
- Research Service, Department of Veteran’s Affairs,
Clement J. Zablocki VA Medical Center, Milwaukee, WI, United States
| | - Jenna Borkenhagen
- Department of Radiation Oncology, Froedtert Hospital &
Medical College of Wisconsin, Milwaukee, WI, United States
| | - Slade Klawikowski
- Department of Radiation Oncology, Froedtert Hospital &
Medical College of Wisconsin, Milwaukee, WI, United States
| | - Daniel Eastwood
- Department of Biostatistics, Medical College of Wisconsin,
Milwaukee, WI, United States
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin,
Milwaukee, WI, United States
| | - Elizabeth R. Jacobs
- Division of Pulmonary Medicine, Department of Medicine,
Froedtert Hospital & Medical College of Wisconsin, Milwaukee, WI, United
States
- Research Service, Department of Veteran’s Affairs,
Clement J. Zablocki VA Medical Center, Milwaukee, WI, United States
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Association between Tunneled Pleural Catheter Use and Infection in Patients Immunosuppressed from Antineoplastic Therapy. A Multicenter Study. Ann Am Thorac Soc 2021; 18:606-612. [PMID: 33026887 DOI: 10.1513/annalsats.202007-886oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Patients with malignant or paramalignant pleural effusions (MPEs or PMPEs) may have tunneled pleural catheter (TPC) management withheld because of infection concerns from immunosuppression associated with antineoplastic therapy.Objectives: To determine the rate of infections related to TPC use and to determine the relationship to antineoplastic therapy, immune system competency, and overall survival (OS).Methods: We performed an international, multiinstitutional study of patients with MPEs or PMPEs undergoing TPC management from 2008 to 2016. Patients were stratified by whether or not they underwent antineoplastic therapy and/or whether or not they were immunocompromised. Cumulative incidence functions and multivariable competing risk regression analyses were performed to identify independent predictors of TPC-related infection. Kaplan-Meier method and multivariable Cox proportional hazards modeling were performed to examine for independent effects on OS.Results: A total of 1,408 TPCs were placed in 1,318 patients. Patients had a high frequency of overlap between antineoplastic therapy and an immunocompromised state (75-83%). No difference in the overall (6-7%), deep pleural (3-5%), or superficial (3-4%) TPC-related infection rates between subsets of patients stratified by antineoplastic therapy or immune status was observed. The median time to infection was 41 (interquartile range, 19-87) days after TPC insertion. Multivariable competing risk analyses demonstrated that longer TPC duration was associated with a higher risk of TPC-related infection (subdistribution hazard ratio, 1.03; 95% confidence interval [CI], 1.00-1.06; P = 0.028). Cox proportional hazards analysis showed antineoplastic therapy was associated with better OS (hazard ratio, 0.84; 95% CI, 0.73-0.97; P = 0.015).Conclusions: The risk of TPC-related infection does not appear to be increased by antineoplastic therapy use or an immunocompromised state. The overall rates of infection are low and comparable with those of immunocompetent patients with no relevant antineoplastic therapy. These results support TPC palliation for MPE or PMPEs regardless of plans for antineoplastic therapy.
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Wang CQ, Huang XR, He M, Zheng XT, Jiang H, Chen Q, Fan TY, Zhan L, Ling J, Feng JH, Xiao X, Chen XF, Xiao Z. Intrapleural Administration With Rh-Endostatin and Chemical Irritants in the Control of Malignant Pleural Effusion: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:649999. [PMID: 34414103 PMCID: PMC8369576 DOI: 10.3389/fonc.2021.649999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/15/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION A modified and recombinant human endostatin (Rh-endostatin) is often used in the control of malignant pleural effusion (MPE) through intrapleural infusion. OBJECTIVES To demonstrate the clinical response, survival, and safety of Rh-endostatin plus chemical irritants, their optimal combinations, treatment threshold, and optimal usage, we performed a new systematic review and meta-analysis. METHODOLOGY All randomized controlled trials (RCTs) were collected from Chinese and English electronic databases (from inception until August 2020). We pooled the data using a series of meta-analyses and summarized the evidence quality following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS We included 75 RCTs recruiting 4,678 patients, which reported six combinations for Rh-endostatin plus chemical irritants. Among the six combinations, only Rh-endostatin plus cisplatin (DDP) with enough trials might improve the complete response [2.29 (1.93, 2.71)] and quality of life [3.01 (2.49, 3.63)] and reduce treatment failure [0.29 (0.25, 0.33)] and progressive disease [0.27 (0.22, 0.34)]. It might not increase the risk of adverse drug reactions. For patients with lung cancer, moderate to massive effusion, initial treatment, Karnofsky Performance Status (KPS) score ≥60, or anticipated survival time ≥3 months, Rh-endostatin (30-45 mg each time, once or twice a week 3-4 times) plus DDP (30-60 mg/m2) obtained a significant improvement in clinical response and a reduction of failure and progressive disease. Most results had good robustness and moderate quality. CONCLUSIONS Current evidence suggests that Rh-endostatin with DDP may be an optimal combination, which may improve clinical response and reduce failure and progressive disease with good safety. Rh-endostatin (30-40 mg each time, once or twice a week 3-4 times) with DDP (30-40 mg/m2) may be an optimal usage for achieving an ideal response.
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Affiliation(s)
- Cheng-Qiong Wang
- Department of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Evidence-Based Medicine Center, MOE Virtual Research Center of Evidence-based Medicine at Zunyi Medical College, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiao-Rong Huang
- GCP Center, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Min He
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiao-Tian Zheng
- Department of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Evidence-Based Medicine Center, MOE Virtual Research Center of Evidence-based Medicine at Zunyi Medical College, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hong Jiang
- Department of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Evidence-Based Medicine Center, MOE Virtual Research Center of Evidence-based Medicine at Zunyi Medical College, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qian Chen
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Teng-Yan Fan
- Department of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Evidence-Based Medicine Center, MOE Virtual Research Center of Evidence-based Medicine at Zunyi Medical College, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lin Zhan
- Laboratory Research Center, Guizhou Provincial People’s Hospital, Guizhou University, Guiyang, China
| | - Juan Ling
- Department of Infection Management, Gansu Provincial People’s Hospital, Lanzhou, China
| | - Ji-Hong Feng
- Department of Oncology, Lishui People’s Hospital, Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Xue Xiao
- Department of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Evidence-Based Medicine Center, MOE Virtual Research Center of Evidence-based Medicine at Zunyi Medical College, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiao-Fan Chen
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Zheng Xiao
- Department of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Evidence-Based Medicine Center, MOE Virtual Research Center of Evidence-based Medicine at Zunyi Medical College, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Cheng C, Yang Y, Yang W, Wang D, Yao C. The diagnostic value of CEA for lung cancer-related malignant pleural effusion in China: a meta-analysis. Expert Rev Respir Med 2021; 16:99-108. [PMID: 34112035 DOI: 10.1080/17476348.2021.1941885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To accurately evaluate the diagnostic value of carcinoembryonic antigen (CEA) for malignant pleural effusion associated with lung cancer in the Chinese population.Methods: Three English databases, PubMed, Embase and Web of Science, and two Chinese databases, China National Knowledge Infrastructure (CNKI) and Wanfang Data, up to 5 November 2020, were searched. The literature on the diagnosis of lung cancer-related malignant pleural effusion by CEA in the Chinese population were collected. The data was analyzed by Stata15.0 software.Results: A total of 15 studies were included in the meta-analysis. The combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio were 0.80 (95% CI: 0.74-0.84), 0.92 (95% CI: 0.89-0.95), 10.46 (95% CI: 7.29-15.00), 0.22 (95% CI: 0.17-0.28), 47.26 (95% CI: 28.84-77.44), respectively . The area under the receiver operating characteristic curve was 0.93 (95% CI: 0.91-0.95). No significant publication bias was found (P > 0.05)Conclusion: CEA has anexcellent diagnostic value for patients with lung cancer-related malignant pleural effusion in the Chinese population.
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Affiliation(s)
- Chen Cheng
- Department of Oncology, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Yongguo Yang
- Department of Pathology, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Wei Yang
- Department of Oncology, Changzhi People's Hospital, Changzhi, Shanxi, China
| | - Daomeng Wang
- Department of Thoracic Surgery, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Chen Yao
- Department of Pathology, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, Jiangsu, China
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Dorry M, Davidson K, Dash R, Jug R, Clarke JM, Nixon AB, Mahmood K. Pleural effusions associated with squamous cell lung carcinoma have a low diagnostic yield and a poor prognosis. Transl Lung Cancer Res 2021; 10:2500-2508. [PMID: 34295657 PMCID: PMC8264347 DOI: 10.21037/tlcr-21-123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/22/2021] [Indexed: 01/01/2023]
Abstract
Background Malignant pleural effusion (MPE) portends a poor prognosis in non-small cell lung cancer (NSCLC). However, the yield of pleural fluid cytology as well as survival of patients with MPE associated with squamous cell carcinoma versus adenocarcinoma is not well understood. We conducted this study to assess the diagnostic yield of pleural cytology and survival of patients with NSCLC related MPE. Methods We performed a single-center, retrospective analysis of patients with NSCLC related MPE between 2010 and 2017. Kaplan-Meier method was used to compare survival and Cox proportional hazards analysis to assess if squamous cell cytopathology was associated with mortality. Results We identified 277 patients, 29 with squamous cell and 248 with adenocarcinoma MPE. Pleural fluid cytology from initial thoracentesis was diagnostic in 13.8% (4/29) patients with squamous cell and 80.2% (199/248) with adenocarcinoma (P<0.001). Cytology from second thoracentesis was diagnostic in 13.3% (2/15) patients with squamous cell carcinoma, compared to 37.5% (12/32) with adenocarcinoma (P=0.17). There was no statistically significant difference in the pleural biopsy yield from medical pleuroscopy or video-assisted thoracoscopic surgery (VATS) in the two groups. The median survival of patients with squamous cell MPE was 112 [interquartile range (IQR): 44-220] days versus 194 (IQR: 54-523) days in adenocarcinoma (Log-rank test P=0.04). Multivariate Cox proportional hazards analysis showed that squamous cell cytopathology was independent predictor of mortality (hazard ratio for death of 1.73, 95% CI: 1.1-2.6; P=0.01). Conclusions Pleural fluid cytology has a low diagnostic yield in squamous cell carcinoma MPE, and these patients have a poor survival compared to lung adenocarcinoma.
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Affiliation(s)
- Michael Dorry
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Kevin Davidson
- Department of Medicine, WakeMed Hospital, Raleigh, NC, USA
| | - Rajesh Dash
- Department of Pathology, Duke University, Durham, NC, USA
| | - Rachel Jug
- Department of Pathology, Duke University, Durham, NC, USA
| | - Jeffrey M Clarke
- Division of Thoracic Oncology, Department of Medicine, Duke University, Durham, NC, USA
| | | | - Kamran Mahmood
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC, USA
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Roh J, Ahn HY, Kim I, Son JH, Seol HY, Kim MH, Lee MK, Eom JS. Clinical course of asymptomatic malignant pleural effusion in non-small cell lung cancer patients: A multicenter retrospective study. Medicine (Baltimore) 2021; 100:e25748. [PMID: 34106603 PMCID: PMC8133234 DOI: 10.1097/md.0000000000025748] [Citation(s) in RCA: 3] [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] [Received: 11/25/2020] [Accepted: 04/07/2021] [Indexed: 11/26/2022] Open
Abstract
The British Thoracic Society guidelines recommend observation for patients with asymptomatic malignant pleural effusion (MPE). However, asymptomatic MPE can become symptomatic. This study examined the clinical course of asymptomatic MPE in patients with non-small cell lung cancer (NSCLC), including the incidence and timing of symptom development of asymptomatic MPE and the associated factors.Retrospective data of 4822 NSCLC patients between January 2012 and December 2017 were reviewed. Symptom development of asymptomatic MPE was defined as the development of symptoms requiring additional treatment, such as insertion of a chest tube, within 1 year in patients who lacked MPE symptoms at the time of diagnosis. Clinical information, pathological parameters, and radiological characteristics were reviewed. Patient data up to 1 year from the initial diagnosis were reviewed.Of 113 patients with asymptomatic MPE, 46 (41%) became symptomatic within 1 year despite appropriate anticancer treatment. The median time to symptom development was 4 months, and 38 patients (83%) developed symptoms within 6 months. Multivariate logistic regression showed that female sex (odds ratio [OR], 0.256; 95% confidence interval [CI], 0.101-0.649; P = .004) and the depth of pleural effusion on initial computed tomography (CT) (OR, 0.957; 95% CI, 0.932-0.982; P = .001) were independently associated with symptom development of asymptomatic MPE.A fraction of 41% of patients with asymptomatic MPE became symptomatic within 1 year. Female sex and larger MPE on initial CT were independently associated with symptom development of asymptomatic MPE.
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Affiliation(s)
- Jiyeon Roh
- Department of Internal Medicine
- Biomedical Research Institute, Pusan National University Hospital
| | - Hyo Yeong Ahn
- Biomedical Research Institute, Pusan National University Hospital
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine
| | - Insu Kim
- Department of Internal Medicine, Dong-A University Hospital, Busan
| | | | - Hee Yun Seol
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | | | | | - Jung Seop Eom
- Department of Internal Medicine
- Biomedical Research Institute, Pusan National University Hospital
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Zhang W, Zhao YL, Li SJ, Zhao YN, Guo NN, Liu B. Complications of thoracoscopic talc insufflation for the treatment of malignant pleural effusions: a meta-analysis. J Cardiothorac Surg 2021; 16:125. [PMID: 33947423 PMCID: PMC8097876 DOI: 10.1186/s13019-021-01475-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Talc pleurodesis is an effective treatment for malignant pleural effusions (MPEs). This study was designed to estimate complication rates of thoracoscopic talc insufflation. Methods Literature search was conducted in electronic databases and studies were selected if they reported complication rates of thoracoscopic talc insufflation in cancer patients with MPEs. Meta-analyses of proportions were performed to obtain incidence rates of complications. Results Twenty-six studies (4482 patients; age 62.9 years [95% confidence interval (CI): 61.5, 64.4]; 50% [95% CI: 43, 58] females) were included. Intraoperative, perioperative, 30-day, and 90-day mortality rates were 0% [95% CI: 0, 1], 2% [95% CI: 0, 4], 7% [95% CI: 3, 13] and 21% [95% CI: 5, 43] respectively. Incidence rates [95% CI] of various complications were: pain (20% [1, 2]), fever (14% [3, 4]), dyspnea (13% [5, 6]), pneumothorax (6% [7, 8]) pneumonia (4% [0, 12]), emphysema (3% [3, 7]), prolonged air leakage (3% [0, 7]), prolonged drainage (3% [9, 10]), thromboembolism (3% [9, 11]), lung injury (2% [7, 12]), respiratory insufficiency (2% [0, 5]), re-expansion pulmonary edema (1% [0, 3]), empyema (1% [0, 2]), respiratory failure (0% [0, 1]), and acute respiratory distress syndrome (ARDS; 0% [0, 1]. Conclusions Whereas pain and fever were the most frequent complications of thoracoscopic talc insufflation, the incidence of ARDS was low. Pneumothorax, pneumonia, emphysema, prolonged air leakage, pulmonary embolism, arrythmia, re-expansion pulmonary edema, and empyema are important complications of thoracoscopic talc insufflation. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01475-1.
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Affiliation(s)
- Wen Zhang
- Department of Chest Surgery, The Fourth Medical Center of PLA General Hospital, No.51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Yun-Long Zhao
- Department of Chest Surgery, The Fourth Medical Center of PLA General Hospital, No.51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Shao-Jun Li
- Department of Chest Surgery, The Fourth Medical Center of PLA General Hospital, No.51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Ying-Nan Zhao
- Department of Chest Surgery, The Fourth Medical Center of PLA General Hospital, No.51, Fucheng Road, Haidian District, Beijing, 100048, China
| | - Nan-Nan Guo
- Department of Chest Surgery, The Fourth Medical Center of PLA General Hospital, No.51, Fucheng Road, Haidian District, Beijing, 100048, China.
| | - Bo Liu
- Department of Chest Surgery, The Fourth Medical Center of PLA General Hospital, No.51, Fucheng Road, Haidian District, Beijing, 100048, China.
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A Retrospective Analysis of the Palliative Surgical Treatment in Patients with Malignant Pleural Effusion. ACTA MEDICA MARTINIANA 2021. [DOI: 10.2478/acm-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Introduction: The formation of malignant pleural effusion (MPE) is a clinical manifestation of an advanced malignancy or its dissemination. The focus of treatment is primarily palliative and aimed at relieving symptoms, especially dyspnoea.
Material and Methods: Clinical data from patients who were hospitalized at the Clinic of Thoracic Surgery, JFMED CU and Martin University Hospital, in the years 2015–2019 were retrospectively explored and statistically analyzed based on their medical records.
Results: From the group of patients with proven MPE (n=67), 32 patients were male (48%) and 35 were female (52%). The mean age was 62.3 years (65.4 for males and 59.4 for females). The three most common primary malignancies were lung cancer (n=24), breast cancer (n=14), and kidney cancer (n=6). In 38 patients with MPE a talc pleurodesis via VATS was performed, with a median survival of 341 days (95% CI 256–859). Drainage following the talc slurry pleurodesis was performed in 10 patients with a median survival of 91.5 days (95% CI 64-NA). Ten patients with MPE underwent drainage only. The overall median survival time after all types of surgical interventions was 301 days (95% CI 207-389 days).
Conclusion: Management of MPE depends on the patient´s prognosis. A definitive intervention is required in patients with a long-term survival, while in patients with a short life expectancy procedures leading to the shortest hospital stay are preferred. Videothoracoscopic procedures with pleurodesis represent an effective treatment for patients with symptomatic MPE with a good performance status, presence of lung re-expansion following pleural drainage or expected survival.
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Spontaneous Improvement of Malignant Pleural Effusion. J Bronchology Interv Pulmonol 2021; 28:e18-e20. [PMID: 32804744 DOI: 10.1097/lbr.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/15/2020] [Indexed: 11/26/2022]
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Lending G, El Ghani YA, Kaykov E, Svirsky B, Cohen HI, Altman E. Hemorrhagic Malignant Pleural Effusion: Diagnosis, Survival Rate, and Response to Talc Pleurodesis. Indian J Surg Oncol 2021; 12:54-60. [PMID: 33814832 PMCID: PMC7960834 DOI: 10.1007/s13193-020-01099-2] [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: 01/24/2020] [Accepted: 05/07/2020] [Indexed: 10/23/2022] Open
Abstract
Hemorrhagic malignant pleural effusion (HMPE) is diagnosed in 47-50% of all malignant pleural effusions (MPE). The aim of this study is to evaluate clinical, radiological, and morphological manifestations of HMPE and results of talc pleurodesis treatment. This is a retrospective review of the medical charts of 135 MPE patients which consists of HMPE group (42 patients) and simple MPE group (63 patients) (median age 67.9 years; 43 males, 62 females). In HMPE vs. simple MPE patients, pronounced dyspnea (100% vs. 88.9%, P = 0.024), chest pain (59.5% vs. 60.3%, P = 1), general deterioration (78.6% vs. 74.6%, P = 0.411) combined with large pleural effusion (81% vs. 50.8%, P = 0.001), and thickening of parietal pleura (73.8% vs. 68.3%, P = 0.349), all were more specific for HMPE. Cytological examination of HMPE showed more malignant pleural fluid cells (81% vs. 63.5%, P = 0.043). Histological examination revealed poorly differentiated types of tumors in 69.05% of HMPE (bronchogenic 33.33%, intestinal 16.67%, breast 14.3%) vs. 7.94% of simple MPE. In 19 HMPE vs. 0 simple MPE patients, thoracoscopy showed bleeding nodules (94.7%) on thickened parietal pleura (84.2%). Pleurodesis with talc by slurry (59%) and poudrage (41%) was less effective in HMPE than in simple MPE patients after 1 month (failed response; 33.3% vs. 21.6, P = 0.019), 3 months (42.9% vs. 25.7%, P = 0.017), and 6 months (42.9% vs. 21.7%, P = 0.035). Survival in HMPE was significantly lower (3.06 months vs. 5.37 months, P = 0.0005). HMPE has more severe clinical, laboratory, radiological, and endoscopic manifestations due to a more poorly differentiated malignant process. Talc pleurodesis was less effective in HMPE, and survival was poor.
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Affiliation(s)
- Gadi Lending
- Department of Internal Medicine – Geriatrics, Western Galilee Medical Center, Route 89 Nahariya-Cabri, PO Box 21, 22100 Nahariya, Israel
| | - Yousef Abed El Ghani
- Department of Internal Medicine – Geriatrics, Western Galilee Medical Center, Route 89 Nahariya-Cabri, PO Box 21, 22100 Nahariya, Israel
| | - Edward Kaykov
- Department of Internal Medicine – Geriatrics, Western Galilee Medical Center, Route 89 Nahariya-Cabri, PO Box 21, 22100 Nahariya, Israel
| | - Boris Svirsky
- Department of Internal Medicine – Geriatrics, Western Galilee Medical Center, Route 89 Nahariya-Cabri, PO Box 21, 22100 Nahariya, Israel
| | - Hector Isaac Cohen
- The Pathology and Cytology Units, Western Galilee Medical Center, Nahariya, Israel
| | - Edward Altman
- Department of Thoracic Surgery, western Galilee medical center, Nahariya, Israel
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Hutchinson AH, Fakhouri EW, Raudales J. Recurrent Large Volume Malignant Pleural Effusion in a Patient With Renal Cell Carcinoma. Cureus 2021; 13:e13593. [PMID: 33815993 PMCID: PMC8009455 DOI: 10.7759/cureus.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Malignant pleural effusion (MPE) due to renal cell carcinoma (RCC) is extremely rare, accounting for only 1%-2% of all malignant pleural effusions. This paper presents a case report of a 56-year-old male who presented with a chief complaint of bilateral flank pain with dyspnea and was diagnosed with RCC via immunopathologic pleural fluid analysis and who persistently had recurrent large volume pleural effusion. A 56-year-old male who had a recent admission for dyspnea secondary to a right-sided pleural effusion underwent thoracentesis and returned to the hospital for his worsening shortness of breath. He was found to have recurrent pleural effusion. Thoracentesis studies revealed an exudative pleural effusion positive for malignant cells showing adenocarcinoma, which had an immunopathologic profile (WT-1 and PAX8) favoring an adenocarcinoma of kidney origin. The patient underwent chest tube placement, followed by chemical pleurodesis with 4.3 L of bloody fluid drained immediately. Subsequent x-rays taken while the chest tube was in place showed worsening reaccumulating pleural effusion. A repeat CT scan showed a large right pleural effusion with loculated collections. The patient then underwent right video-assisted thoracoscopic surgery, which revealed a loculated effusion with pleural carcinomatosis that was biopsy-positive for RCC. This report presents a rare case displaying how RCC pleural carcinomatosis can cause a patient to present with dyspnea secondary to a pleural effusion, which was revealed to be RCC upon fluid cytology and immunohistopathology studies. This case demonstrates that RCC can cause recurrent large volume MPE, which has not been widely reported in contemporary literature.
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Affiliation(s)
- Akil H Hutchinson
- Internal Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Eddie W Fakhouri
- Internal Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Juan Raudales
- Internal Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
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Pleurodesis: From Thoracic Surgery to Interventional Pulmonology. Respir Med 2021. [DOI: 10.1007/978-3-030-80298-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Choudhury A, Sarkar S, Magoon R, Sahoo S. Erector spinae plane block: An effective analgesic technique for pleurodesis after senning operation. Ann Card Anaesth 2021; 24:263-265. [PMID: 33884992 PMCID: PMC8253038 DOI: 10.4103/aca.aca_105_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pain emanating from pleurodesis is significantly distressing and presents an important management concern. Despite encouraging evidence on the application of fascial plane blocks for cardiothoracic surgery, the literature on the use of erector spinae block for pleurodesis remains scarce. We describe a case of bilateral recurrent pleural effusion following congenital heart surgery where erector spinae block was employed as an analgesic technique for pleurodesis. Finally, we discuss its regional analgesic effects in comparison to the conventional intravenous/systemic analgesia in a cross over fashion.
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Affiliation(s)
| | | | - Rohan Magoon
- Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India
| | - Subhajit Sahoo
- Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India
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The Inflammatory Cytokine Profile of Patients with Malignant Pleural Effusion Treated with Pleurodesis. J Clin Med 2020; 9:jcm9124010. [PMID: 33322487 PMCID: PMC7763363 DOI: 10.3390/jcm9124010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 12/27/2022] Open
Abstract
Patients with malignant pleural effusion (MPE) who underwent successful pleurodesis survive longer than those for whom it fails. We hypothesize that the therapy-induced inflammatory responses inhibit the cancer progression, and thereby lead to a longer survival. Thirty-three consecutive patients with MPE that were eligible for bleomycin pleurodesis between September 2015 and December 2017 were recruited prospectively. Nineteen patients (57.6%) achieved fully or partially successful pleurodesis, while 14 patients either failed or survived less than 30 days after pleurodesis. Two patients without successful pleurodesis were excluded because of missing data. Interleukin (IL)-1 beta, IL-6, IL-10, transforming growth factor beta, tumor necrosis factor alpha (TNF-α), and vascular endothelial growth factor in the pleural fluid were measured before, and after 3 and 24 h of pleurodesis. Their pleurodesis outcome and survival were monitored and analyzed. Patients who underwent successful pleurodesis had a longer survival rate. Patients without successful pleurodesis had significantly higher TNF-α and IL-10 levels in their pleural fluid than in the successful patients before pleurodesis. Following pleurodesis, there was a significant increment of IL-10 in the first three hours in the successful patients. In contrast, significant increments of TNF-α and IL-10 were found in the unsuccessful patients between 3 and 24 h after pleurodesis. The ability to produce specific cytokines in the pleural space following pleurodesis may be decisive for the patient’s outcome and survival. Serial measurement of cytokines can help allocate the patients to adequate treatment strategies. Further study of the underlying mechanism may shed light on cytokine therapies as novel approaches.
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Beltsios ET, Mavrovounis G, Adamou A, Panagiotopoulos N. Talc pleurodesis in malignant pleural effusion: a systematic review and meta-analysis. Gen Thorac Cardiovasc Surg 2020; 69:832-842. [PMID: 33222091 DOI: 10.1007/s11748-020-01549-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Malignant pleural effusion is a severe and common complication in patients with primary or metastatic malignancies of the pleura. Although talc pleurodesis is widely used for managing malignant pleural effusions, there is still controversy in the literature regarding its superiority compared to other approaches. We conducted this meta-analysis to further investigate its efficacy compared to alternative interventions. METHODS We systematically reviewed the PubMed, Cochrane, and Scopus databases to identify studies that fulfilled our inclusion criteria. Study quality was evaluated using validated tools and the pooled Risk Ratio (RR) and confidence interval (CI) were calculated. We performed sensitivity analyses based on the meta-analysis method and type of study. RESULTS Twenty-four studies were included in the current systematic review meta-analysis. Talc pleurodesis was associated with statistically significant higher successful pleurodesis rates when compared with all controls [RR (95% CI) 1.15 (1.00, 1.31); Pz = 0.04], only chemical controls [RR (95% CI) 1.26 (1.13, 1.40); Pz < 0.0001], and bleomycin [RR (95% CI) 1.22 (1.05, 1.42); Pz = 0.008]. The comparison between talc pleurodesis and controls at the > 1-month follow-up time point favored talc pleurodesis [RR (95% CI): 1.62 (1.15, 2.27); Pz = 0.005]. Finally, talc poudrage was associated with a statistically significant higher successful pleurodesis rate when compared with all controls. Sensitivity analyses verified the robustness of our results. CONCLUSION Talc pleurodesis is an effective MPE management approach presenting borderline statistically significant superiority compared to control methods especially compared to bleomycin as well as when pleurodesis success is evaluated later than 1 month postoperatively.
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Affiliation(s)
- Eleftherios T Beltsios
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK. .,Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500, Larissa, Biopolis, Greece.
| | - Georgios Mavrovounis
- Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500, Larissa, Biopolis, Greece
| | - Antonis Adamou
- Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500, Larissa, Biopolis, Greece.,Department of Radiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Jeffries J, Gayed M, Ha TGV, Navuluri R. Management of Malignant Pleural Effusions and Malignancy-Related Ascites. Semin Intervent Radiol 2020; 37:434-440. [PMID: 33041492 PMCID: PMC7540637 DOI: 10.1055/s-0040-1715885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- James Jeffries
- Section of Interventional Radiology, Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Matthew Gayed
- Section of Interventional Radiology, Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Thuong G. Van Ha
- Section of Interventional Radiology, Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Rakesh Navuluri
- Section of Interventional Radiology, Department of Radiology, The University of Chicago, Chicago, Illinois
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Faisal M, Nurhanis S, Nik Abeed NN, Ng BH, Ban AY. Re-establishing indwelling pleural catheter patency with alteplase after failure of streptokinase. Respirol Case Rep 2020; 8:e00639. [PMID: 32774860 PMCID: PMC7406907 DOI: 10.1002/rcr2.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/07/2022] Open
Abstract
Indwelling pleural catheter (IPC) has revolutionized the management of malignant pleural effusion (MPE). IPC is relatively safe, although complications can occur. We report a 53-year-old woman with stage IVA lung adenocarcinoma and recurrent MPE. Two months post insertion, the IPC was blocked with residual effusion and presence of new loculations. Attempts to restore patency with six doses of intrapleural (IP) streptokinase failed. She was referred to our centre for further management. We used a single dose of 2.5 mg IP alteplase which was successful in establishing patency of the IPC and draining the effusion. This case highlights the safety and efficacy of IP alteplase via IPC following a failed instillation of streptokinase.
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Affiliation(s)
- Mohamed Faisal
- Respiratory Unit, Department of Medicine, Faculty of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Siti Nurhanis
- Respiratory Unit, Department of Medicine, Faculty of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Nik Nuratiqah Nik Abeed
- Respiratory Unit, Department of Medicine, Faculty of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Boon Hau Ng
- Respiratory Unit, Department of Medicine, Faculty of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Andrea Yu‐Lin Ban
- Respiratory Unit, Department of Medicine, Faculty of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
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Malignant Pleural Effusion: Diagnosis and Management. Can Respir J 2020; 2020:2950751. [PMID: 33273991 PMCID: PMC7695997 DOI: 10.1155/2020/2950751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/05/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022] Open
Abstract
Symptomatic malignant pleural effusion is a common clinical problem. This condition is associated with very high mortality, with life expectancy ranging from 3 to 12 months. Studies are contributing evidence on an increasing number of therapeutic options (therapeutic thoracentesis, thoracoscopic pleurodesis or thoracic drainage, indwelling pleural catheter, surgery, or a combination of these therapies). Despite the availability of therapies, the management of malignant pleural effusion is challenging and is mainly focused on the relief of symptoms. The therapy to be administered needs to be designed on a case-by-case basis considering patient's preferences, life expectancy, tumour type, presence of a trapped lung, resources available, and experience of the treating team. At present, the management of malignant pleural effusion has evolved towards less invasive approaches based on ambulatory care. This approach spares the patient the discomfort caused by more invasive interventions and reduces the economic burden of the disease. A review was performed of the diagnosis and the different approaches to the management of malignant pleural effusion, with special emphasis on their indications, usefulness, cost-effectiveness, and complications. Further research is needed to shed light on the current matters of controversy and help establish a standardized, more effective management of this clinical problem.
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Choi H, Ko Y, Lee CY. Pro-cathepsin D as a diagnostic marker in differentiating malignant from benign pleural effusion: a retrospective cohort study. BMC Cancer 2020; 20:825. [PMID: 32867726 PMCID: PMC7457471 DOI: 10.1186/s12885-020-07327-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 08/20/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Malignant pleural effusion (MPE) causes substantial symptomatic burden in advanced malignancy. Although pleural fluid cytology is a commonly accepted gold standard of diagnosis, its low diagnostic yield is a challenge for clinicians. The aim of this study was to determine whether pro-cathepsin D can serve as a novel biomarker to discriminate between MPE and benign pleural effusion (BPE). METHODS This study included 81 consecutive patients with exudative pleural effusions who had underwent thoracentesis or 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). The discriminative power of pleural fluid pro-cathepsin D for diagnosing MPE was moderate, with 81% sensitivity and 53% specificity at a pro-cathepsin D cut-off ≥0.596 pg/mL (area under the curve: 0.656). Positive and negative predictive values for MPE were 38 and 89%, respectively, with pro-cathepsin D cut-off value (> 0.596 pg/mL). CONCLUSIONS The level of pleural fluid pro-cathepsin D was found to be significantly higher in MPE than in BPE. Although results of this study could not support the sole use of pleural fluid pro-cathepsin D to diagnose MPE, pleural fluid pro-cathepsin D can be added to pre-existing diagnostic methods for ruling-in or ruling-out MPE.
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Affiliation(s)
- Hayoung Choi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.,Lung Research Institute of Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Yousang Ko
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Republic of Korea.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Chang Youl Lee
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Republic of Korea. .,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea.
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Desai NR, French KD, Kovitz KL. Basic and Advanced Pleural Procedures: Coding and Professional Fees Update for Pulmonologists. Chest 2020; 158:2517-2523. [PMID: 32882245 DOI: 10.1016/j.chest.2020.08.2070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 02/05/2023] Open
Abstract
There is an evolution of pleural procedures that involve broadened clinical indication and expanded scope that include advanced diagnostic, therapeutic, and palliative procedures. Finance and clinical professionals have been challenged to understand the indication and coding complexities that accompany these procedures. This article describes the utility of pleural procedures, the appropriate current procedural terminology coding, and necessary modifiers. Coding pearls that help close the knowledge gap between basic and advanced procedures aim to address coding confusion that is prevalent with pleural procedures and the risk of payment denials, potential underpayment, and documentation audits.
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Affiliation(s)
- Neeraj R Desai
- Chicago Chest Center, Elk Grove Village, IL; AMITA Health, Lisle, IL; Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL.
| | - Kim D French
- Chicago Chest Center, Elk Grove Village, IL; AMITA Health, Lisle, IL
| | - Kevin L Kovitz
- Chicago Chest Center, Elk Grove Village, IL; AMITA Health, Lisle, IL; Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL
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Characteristics of Malignant Pleural Effusion Resident CD8 + T Cells from a Heterogeneous Collection of Tumors. Int J Mol Sci 2020; 21:ijms21176178. [PMID: 32867034 PMCID: PMC7503595 DOI: 10.3390/ijms21176178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 12/22/2022] Open
Abstract
While T cell-based cancer immunotherapies have shown great promise, there remains a need to understand how individual metastatic tumor environments impart local T cell dysfunction. At advanced stages, cancers that metastasize to the pleural space can result in a malignant pleural effusion (MPE) that harbors abundant tumor and immune cells, often exceeding 108 leukocytes per liter. Unlike other metastatic sites, MPEs are readily and repeatedly accessible via indwelling catheters, providing an opportunity to study the interface between tumor dynamics and immunity. In the current study, we examined CD8+ T cells within MPEs collected from patients with heterogeneous primary tumors and at various stages in treatment to determine (1) if these cells possess anti-tumor activity following removal from the MPE, (2) factors in the MPE that may contribute to their dysfunction, and (3) the phenotypic changes in T cell populations that occur following ex vivo expansion. Co-cultures of CD8+ T cells with autologous CD45- tumor containing cells demonstrated cytotoxicity (p = 0.030) and IFNγ production (p = 0.003) that inversely correlated with percent of myeloid derived suppressor cells, lactate, and lactate dehydrogenase (LDH) within the MPE. Ex vivo expansion of CD8+ T cells resulted in progressive differentiation marked by distinct populations expressing decreased CD45RA, CCR7, CD127, and increased inhibitory receptors. These findings suggest that MPEs may be a source of tumor-reactive T cells and that the cellular and acellular components suppress optimal function.
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46
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Broome DT, Gadre GB, Fayazzadeh E, Bena JF, Nasr C. Pleural effusion as a novel prognostic factor in metastatic thyroid carcinoma. Endocr Connect 2020; 9:812-823. [PMID: 32738128 PMCID: PMC7487194 DOI: 10.1530/ec-20-0193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/28/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To identify novel prognostic risk factors and compare them with other known prognostic risk factors in follicular-cell-derived thyroid carcinoma (FDTC) with distant metastases. METHODS A retrospective review was conducted of adult patients with metastatic FDTC seen at a tertiary care center between January 1990 and December 2010. A 15-year Kaplan-Meier survival estimate was created for overall survival (OS) and cancer-specific survival (CSS). Hazard ratios (HR) and P values from Cox proportional hazard models were used with a 95% CI. RESULTS There were 143 patients (60.1% male, 39.9% female), of whom 104 (72.7%) patients had papillary, 30 (21.0%) had follicular, 5 (3.5%) had poorly differentiated, and 4 (2.8%) had Hürthle cell cancers. Median length of follow-up was 80.0 months (range 1.0-564.0). The 15-year mortality rate was 32.2% and cancer-specific mortality was 25.2%, with OS and CSS having the same risk factors. Lung was the most common site of metastases in 53 patients (37.1%), and patients with pleural effusions had significantly lower CSS (HR = 5.21, CI = 1.79-15.12). Additional risk factors for a decreased CSS included: older age upon diagnosis (>45 years, HR = 4.15, CI = 1.43-12.02), multiple metastatic locations (HR = 3.75, CI = 1.32-10.67), and incomplete/unknown tumor resection (HR = 2.35, CI = 1.18-4.67). CONCLUSION This study is the first to demonstrate that pleural effusion is a poor prognostic sign in patients with FDTC with distant metastases and compare this risk with other accepted prognostic variables.
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Affiliation(s)
- David T Broome
- Department of Endocrinology, Diabetes & Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Gauri B Gadre
- Department of Internal Medicine, Scripps Clinic, La Jolla, California, USA
| | - Ehsan Fayazzadeh
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - James F Bena
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Christian Nasr
- Department of Endocrinology, Diabetes & Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Correspondence should be addressed to C Nasr:
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Lee J, Lee YH, Seo H, Do YW, Lee DH, Lee SY, Lim JK, Yoo SS, Lee SY, Cha SI, Park JY, Kim CH. Characteristics and survival impact of polymorphonuclear leucocyte-predominant malignant pleural effusions secondary to lung cancer. THE CLINICAL RESPIRATORY JOURNAL 2020; 14:772-779. [PMID: 32294312 DOI: 10.1111/crj.13195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/13/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION In comparison with mononuclear leucocyte (MNL)-predominant malignant pleural effusions (MPEs), polymorphonuclear leucocyte (PMNL)-predominant MPEs have rarely been investigated and may be associated with a poorer prognosis. OBJECTIVES To investigate the characteristics and survival impact of PMNL-predominant MPEs secondary to lung cancer. METHODS This retrospective study included patients with MPE secondary to lung cancer, which were classified into the PMNL- and MNL-predominant groups according to cellular predominance in the pleural fluid. Clinical, hematological, radiological, and pleural fluid data were compared between the groups, and the survival impact of PMNL predominance in MPE was evaluated. RESULTS Of the 193 MPEs included, 37 (19%) were characterised by PMNL predominance. Compared to the MNL-predominant group, the PMNL-predominant group showed significantly poorer patient performances (P = .001), higher white blood cell counts (P = .009), higher neutrophil counts, higher blood neutrophil-to-lymphocyte ratio (P = .046), higher serum C-reactive protein (P = .003), lower serum albumin (P < .001), lower pleural fluid pH (P = .002) and higher pleural fluid lactate dehydrogenase (P = .029) levels. In contrast, most clinical and radiological findings, including the duration of symptoms, showed no significant intergroup differences. A shift towards MNL predominance was observed in only 38% of the PMNL-predominant patients who underwent repeat thoracentesis. Overall survival of the PMNL-predominant group was significantly shorter than the MNL-predominant group (P = .003). CONCLUSIONS PMNL predominance in MPEs secondary to lung cancer may be observed in variable phases with respect to the duration of symptoms and the time of thoracentesis. Overall, PMNL-predominant MPEs were associated with more advanced stages and poorer survival outcomes, compared to MNL-predominant MPEs.
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Affiliation(s)
- Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong Hoon Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyewon Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Young Woo Do
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sang Yub Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Soo Yoo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Shin Yup Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae Yong Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chang Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Díaz Del Arco C, Saiz-Pardo Sanz M, Ortega Medina L, Fernández Aceñero MJ. Ber-EP4 staining in effusion cytology: A potential source of false positives. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2020; 54:114-122. [PMID: 33726887 DOI: 10.1016/j.patol.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/21/2020] [Accepted: 04/25/2020] [Indexed: 10/23/2022]
Abstract
The distinction between reactive mesothelium and carcinoma in serous effusions can be very difficult. Immunocytochemistry (ICC) is the most widely used tool to improve the diagnostic accuracy of body fluid cytology, with several ICC markers being proposed. Ber-EP4 antibody has shown high sensitivity and specificity rates for diagnosing metastatic carcinoma. In our department, we have detected Ber-EP4 positivity in mesothelium in some cytological specimens. We reviewed all articles on Ber-EP4 staining in effusion cytology, summarized current findings and analyzed the staining pattern of all cases expressing Ber-EP4. Some cases showing Ber-EP4 positivity in mesothelium have been reported, most of which showed only weak Ber-EP4 staining or staining of less than 50% of mesothelial cells. However, some cases may show strong positivity both in cytological and histological specimens. Clinicians and pathologists should be aware of this source of misdiagnosis, and ICC results in mesothelium should be always interpreted cautiously and correlated with clinical tests, other ICC markers and patient's previous history.
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Affiliation(s)
| | | | - Luis Ortega Medina
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
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Banka R, George V, Rahman NM. Multidisciplinary approaches to the management of malignant pleural effusions: a guide for the clinician. Expert Rev Respir Med 2020; 14:1009-1018. [PMID: 32634337 DOI: 10.1080/17476348.2020.1793672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Malignant pleural effusion (MPE) is a complication of advanced cancer, associated with significant mortality and morbidity. This entity is commonly treated by respiratory physicians, oncologists, and thoracic surgeons. There have been various randomized clinical trials assessing the relative merits of chest drain pleurodesis, indwelling pleural catheters, treatment of septated MPEs, the use of thoracoscopy and pleurodesis and pleurodesis through IPCs in the past decade which have addressed some key areas in the management of MPEs, with an increasing focus on patient related outcome. AREAS COVERED In this review, we examine and review the literature for management strategies for MPEs and discuss future directions. A detailed search of scientific literature and clinical trial registries published in the past two decades was undertaken. EXPERT OPINION Tremendous progress has been made in management of MPE in the past decade and current strategy involves patient preference along with local expertise that is available.
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Affiliation(s)
- Radhika Banka
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust , Oxford, UK
| | - Vineeth George
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust , Oxford, UK
| | - 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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Thomas R, Rahman NM, Maskell NA, Lee YCG. Pleural effusions and pneumothorax: Beyond simple plumbing: Expert opinions on knowledge gaps and essential next steps. Respirology 2020; 25:963-971. [PMID: 32613624 DOI: 10.1111/resp.13881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/15/2020] [Accepted: 04/29/2020] [Indexed: 12/17/2022]
Abstract
Pleural diseases affect millions of people worldwide. Pleural infection, malignant pleural diseases and pneumothorax are common clinical challenges. A large number of recent clinical trials have provided an evidence-based platform to evaluate conventional and novel methods to drain pleural effusions/air which reduce morbidity and unnecessary interventions. These successes have generated significant enthusiasm and raised the profile of pleural medicine as a new subspecialty. The ultimate goal of pleural research is to prevent/stop development of pleural effusions/pneumothorax. Current research studies mainly focus on the technical aspects of pleural drainage. Significant knowledge gaps exist in many aspects such as understanding of the pathobiology of the underlying pleural diseases, pharmacokinetics of pleural drug delivery, etc. Answers to these important questions are needed to move the field forward. This article collates opinions of leading experts in the field in highlighting major knowledge gaps in common pleural diseases to provoke thinking beyond pleural drainage. Recognizing the key barriers will help prioritize future research in the quest to ultimately cure (rather than just drain) these pleural conditions.
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Affiliation(s)
- Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, Bristol Medical School, University of Bristol, Bristol, UK.,North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
| | - Y C Gary Lee
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia.,Centre for Respiratory Health, School of Medicine, University of Western Australia, Perth, WA, Australia
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